Healthcare Provider Details

I. General information

NPI: 1669697652
Provider Name (Legal Business Name): WOUND AND ULCER CARE CLINIC OF SAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. DOMENECH 385
SAN JUAN PR
00918
US

IV. Provider business mailing address

AVE. DOMENECH 385
SAN JUAN PR
00918
US

V. Phone/Fax

Practice location:
  • Phone: 787-751-1110
  • Fax: 787-771-9715
Mailing address:
  • Phone: 787-751-1110
  • Fax: 787-771-9715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LETICIA VELLEJO CARMONA
Title or Position: ADMINISTRATOR
Credential: R.N., B.S.N., C.W.S.
Phone: 787-751-1110