Healthcare Provider Details

I. General information

NPI: 1346037405
Provider Name (Legal Business Name): OPEN CARE WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 06/22/2025
Certification Date: 06/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 909 KM. 0.4 BO. MARIANA
HUMACAO PR
00791
US

IV. Provider business mailing address

5031 TINTILLO HILLS
GUAYNABO PR
00966
US

V. Phone/Fax

Practice location:
  • Phone: 787-941-7272
  • Fax:
Mailing address:
  • Phone: 787-237-1412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: LUIS M MARTINEZ
Title or Position: PRESIDENT
Credential:
Phone: 787-237-1412