Healthcare Provider Details

I. General information

NPI: 1548710486
Provider Name (Legal Business Name): WOUNDHEAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

479 CALLE CESAR GONZALEZ
SAN JUAN PR
00918-2637
US

IV. Provider business mailing address

1353 AVE LUIS VIGOREAUX PMB 305
GUAYNABO PR
00966-2715
US

V. Phone/Fax

Practice location:
  • Phone: 787-200-7832
  • Fax:
Mailing address:
  • Phone: 787-200-7832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MR. JORGE SURIA
Title or Position: CONTABILIDAD
Credential:
Phone: 787-200-7832