Healthcare Provider Details

I. General information

NPI: 1790612885
Provider Name (Legal Business Name): ETTHELIUS HEALTHCARE MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. PERLA DEL SUR CALLE PASEO DEL SUR 2433 LOCAL 1
PONCE PR
00716
US

IV. Provider business mailing address

URB. PERLA DEL SUR CALLE PASEO DEL SUR 2433 LOCAL 1
PONCE PR
00716
US

V. Phone/Fax

Practice location:
  • Phone: 939-217-2022
  • Fax: 787-651-3343
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: JEAN C CASTRERO CORREA
Title or Position: PRESIDENT
Credential: LIC
Phone: 939-759-3503