Healthcare Provider Details

I. General information

NPI: 1821174038
Provider Name (Legal Business Name): VIANNEY WOUND CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 10/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 115 KM 16.3
RINCON PR
00677-1112
US

IV. Provider business mailing address

PO BOX 1112
RINCON PR
00677-1112
US

V. Phone/Fax

Practice location:
  • Phone: 787-823-3330
  • Fax: 787-823-3330
Mailing address:
  • Phone: 787-823-3330
  • Fax: 787-823-3330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number01279
License Number StatePR

VIII. Authorized Official

Name: EDWIN VENEZUELA
Title or Position: PRESIDENT
Credential:
Phone: 787-823-3330