Healthcare Provider Details

I. General information

NPI: 1609199306
Provider Name (Legal Business Name): HEALTH MED CARE,CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 668 FELIX CORDOBA DAVILA 158
MANATI PR
00674
US

IV. Provider business mailing address

16 CALLE L PARC. RODRIGUEZ OLMO
ARECIBO PR
00612-4201
US

V. Phone/Fax

Practice location:
  • Phone: 787-458-2300
  • Fax:
Mailing address:
  • Phone: 787-458-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number14451
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierBC8006149
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerFEDERAL

VIII. Authorized Official

Name: MRS. MIDALIE J CABAN
Title or Position: PRESIDENT
Credential: MD
Phone: 787-458-2300