Healthcare Provider Details

I. General information

NPI: 1104302538
Provider Name (Legal Business Name): CARIBBEAN WOUND CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GO4 B AVE CAMPO RICO URB COUNTRY CLUB
CAROLINA PR
00982
US

IV. Provider business mailing address

PO BOX 1792
CAROLINA PR
00984-1792
US

V. Phone/Fax

Practice location:
  • Phone: 787-430-0314
  • Fax: 787-750-0195
Mailing address:
  • Phone: 787-430-0314
  • Fax: 787-750-0195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number25552
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number30381
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number25552
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number30381
License Number StatePR
# 5
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number30381
License Number StatePR
# 6
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number25552
License Number StatePR
# 7
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number25552
License Number StatePR
# 8
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number30381
License Number StatePR
# 9
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number8617
License Number StatePR
# 10
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number8617
License Number StatePR
# 11
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number8617
License Number StatePR
# 12
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number8617
License Number StatePR

VIII. Authorized Official

Name: DR. VICTOR RICARDO ARRIETA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-430-0314