Healthcare Provider Details

I. General information

NPI: 1952475535
Provider Name (Legal Business Name): PRANG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CAMP SANTIAGO
SALINAS PR
00751
US

IV. Provider business mailing address

PO BOX 2131
YAUCO PR
00698-2131
US

V. Phone/Fax

Practice location:
  • Phone: 787-824-2022
  • Fax:
Mailing address:
  • Phone: 787-267-1307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number0900
License Number StatePR

VIII. Authorized Official

Name: MARTA CARCANA
Title or Position: DEPTY STATE SURGEON
Credential: RN
Phone: 787-289-1656