=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336700384
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCS THERAPEUTIC CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2019
-----------------------------------------------------
Last Update Date | 06/20/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2345 STANFORD CT STE 603
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34112-4841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-331-3482
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2345 STANFORD CT STE 603
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34112-4841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-331-3482
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MAYQUEL SALGADO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 239-331-3482
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------