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General NPI Number Information
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NPI Number | 1306223797
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Entity Type | Organization
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Legal Business Name | M.C.M ULCER CARE
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Dates
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Enumeration Date | 05/05/2015
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Last Update Date | 05/05/2015
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Provider Practice Location Address
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Address Line | HC 3 BOX 32695
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City | AGUADA
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State | PR
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Zip | 00602-9764
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Country | US
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Telephone | 787-202-1357
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Fax |
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Provider Business Mailing Address
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Address Line | HC 3 BOX 32695
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City | AGUADA
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State | PR
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Zip | 00602-9764
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Country | US
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Telephone | 787-202-1357
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Fax |
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Authorized Official
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Title or Position | ENFERMERA GENERALITA
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Name | MS. MARILYN CRUZ MONTALVO
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Credential | BACHILLERATO
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Telephone | 787-202-1357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | 73498
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License Number State | PR
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