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General NPI Number Information
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NPI Number | 1174404669
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Entity Type | Organization
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Legal Business Name | PUEBLO CARE NY LLC
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Dates
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Enumeration Date | 09/10/2025
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 333 W COMMERCIAL ST FL 3
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City | EAST ROCHESTER
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State | NY
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Zip | 14445-2400
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Country | US
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Telephone | 315-353-9191
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Fax |
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Provider Business Mailing Address
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Address Line | 333 W COMMERCIAL ST FL 3
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City | EAST ROCHESTER
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State | NY
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Zip | 14445-2400
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Country | US
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Telephone | 315-353-9191
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARIO R ANGLADA CORTES
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Credential | MBA
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Telephone | 720-761-1362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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