Healthcare Provider Details

I. General information

NPI: 1801026729
Provider Name (Legal Business Name): PRESTIGE WOUND CARE, CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 06/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 153 KM 9.5
SANTA ISABEL PR
00757
US

IV. Provider business mailing address

PO BOX 2042
COAMO PR
00769-4042
US

V. Phone/Fax

Practice location:
  • Phone: 787-845-8100
  • Fax: 787-845-8101
Mailing address:
  • Phone: 787-845-8100
  • Fax: 787-845-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberAMP451
License Number StatePR

VIII. Authorized Official

Name: MR. JOEL ESPINOSA
Title or Position: PRESIDENT
Credential:
Phone: 787-845-8100