Healthcare Provider Details

I. General information

NPI: 1417367681
Provider Name (Legal Business Name): NANCY WILLIAMS MALTES PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1128 AVE MUNOZ RIVERA RPTO. UNIVERSITARIO
PONCE PR
00717-0643
US

IV. Provider business mailing address

PO BOX 10038
PONCE PR
00732-0038
US

V. Phone/Fax

Practice location:
  • Phone: 787-848-0405
  • Fax: 787-290-3535
Mailing address:
  • Phone: 787-848-0405
  • Fax: 787-290-3535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number704
License Number StatePR

VIII. Authorized Official

Name: NANCY WILLIAMS
Title or Position: PRESIDENT
Credential: M.T.
Phone: 787-848-0405