=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417367681
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NANCY WILLIAMS MALTES PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2014
-----------------------------------------------------
Last Update Date | 07/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1128 AVE MUNOZ RIVERA RPTO. UNIVERSITARIO
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00717-0643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-848-0405
-----------------------------------------------------
Fax | 787-290-3535
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 10038
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00732-0038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-848-0405
-----------------------------------------------------
Fax | 787-290-3535
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | NANCY WILLIAMS
-----------------------------------------------------
Credential | M.T.
-----------------------------------------------------
Telephone | 787-848-0405
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 704
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------