=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497150320
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARALANA CSP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2014
-----------------------------------------------------
Last Update Date | 05/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | COLISEO SHOPPING 2525 AVE EDUARDO RUBERTE SUITE 101
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00728-2813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-259-5990
-----------------------------------------------------
Fax | 787-973-5991
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7122
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00732-7122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-259-5990
-----------------------------------------------------
Fax | 787-259-5990
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | ARMANDO WISCOVITCH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 787-259-5990
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 9858
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------