Healthcare Provider Details

I. General information

NPI: 1053573543
Provider Name (Legal Business Name): HOME MEDIC COORDINATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE LUIS MUNOZ RIVERA EDIF 91 ALTOS
SANTA ISABEL PR
00757
US

IV. Provider business mailing address

PO BOX 57
SANTA ISABEL PR
00757-0057
US

V. Phone/Fax

Practice location:
  • Phone: 787-845-1188
  • Fax: 787-845-2653
Mailing address:
  • Phone: 787-845-1188
  • Fax: 787-845-2653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. CARLOS LUIS LEON
Title or Position: PRESIDENT
Credential:
Phone: 787-845-1188