Healthcare Provider Details

I. General information

NPI: 1316281256
Provider Name (Legal Business Name): DOMICILIARY CARE ORGANIZATION OF PUERTO RICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 CALLE MUNOZ RIVERA
JUNCOS PR
00777-3112
US

IV. Provider business mailing address

49 CALLE MUNOZ RIVERA
JUNCOS PR
00777-3112
US

V. Phone/Fax

Practice location:
  • Phone: 787-743-0525
  • Fax:
Mailing address:
  • Phone: 787-743-0525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JORGE LUIS LOPEZ ROCAFORT
Title or Position: PRESIDENT
Credential:
Phone: 787-743-0525