Healthcare Provider Details

I. General information

NPI: 1952730699
Provider Name (Legal Business Name): HUMED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 1 A1 CARR. 924 STE 4 URB. SAN ANTONIO
HUMACAO PR
00791
US

IV. Provider business mailing address

CALLE 1 A1 CARR. 924 STE 4 URB. SAN ANTONIO
HUMACAO PR
00791
US

V. Phone/Fax

Practice location:
  • Phone: 787-810-1868
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number208D0000X
License Number StatePR

VIII. Authorized Official

Name: MS. MILITZA CANINO
Title or Position: MEDICINE DOCTOR
Credential: M.D.
Phone: 787-810-1868