Healthcare Provider Details

I. General information

NPI: 1245552272
Provider Name (Legal Business Name): VENUS GARDENS MANOR CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2010
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 CALLE ACUARIO URB. VENUS GARDENS
SAN JUAN PR
00926-4814
US

IV. Provider business mailing address

PO BOX 34243 FT. BUCHANAN
FORT BUCHANAN PR
00934-0243
US

V. Phone/Fax

Practice location:
  • Phone: 787-748-7242
  • Fax:
Mailing address:
  • Phone: 787-748-7242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number09-10-160 SJ
License Number StatePR

VIII. Authorized Official

Name: MRS. MARGARITA APONTE
Title or Position: PRESIDENTE
Credential:
Phone: 787-748-7242