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General NPI Number Information
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NPI Number | 1508102518
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Entity Type | Organization
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Legal Business Name | LDCA ENTERPRISE INC
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Dates
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Enumeration Date | 12/19/2012
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Last Update Date | 08/06/2015
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Provider Practice Location Address
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Address Line | CARR 125 KM 21.9 BO. BAHOMAMEY SAN SEBASTIAN MEDICAL CENTER SUITE # 4
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City | SAN SEBASTIAN
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State | PR
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Zip | 00685
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Country | US
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Telephone | 787-926-7999
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Fax | 787-926-7899
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Provider Business Mailing Address
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Address Line | PO BOX 902
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City | SAN SEBASTIAN
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State | PR
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Zip | 00685-0902
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARLOS VILLAHERMOSA
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Credential | CPC , PMB
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Telephone | 787-374-7467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 16-F-3080
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License Number State | PR
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