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General NPI Number Information
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NPI Number | 1063058287
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Entity Type | Organization
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Legal Business Name | ENDOCRINOLOGY WELLNESS CENTER LLC
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Dates
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Enumeration Date | 11/22/2019
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Last Update Date | 11/22/2019
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Provider Practice Location Address
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Address Line | EDIFICIO LA PALMA 19 CALLE PERAL
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City | MAYAGUEZ
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State | PR
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Zip | 00680
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Country | US
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Telephone | 787-644-2002
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1431
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City | RINCON
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State | PR
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Zip | 00677-1431
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Country | US
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Telephone | 787-644-2002
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KYRMARIE M DAVILA TORRES
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Credential | MD
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Telephone | 787-458-5858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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