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General NPI Number Information
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NPI Number | 1659918605
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Entity Type | Organization
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Legal Business Name | MK ENTERPRISE INC
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Dates
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Enumeration Date | 12/09/2019
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Last Update Date | 12/09/2019
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Provider Practice Location Address
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Address Line | COMMERCE PLAZA SUITE 302
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City | GUAYAMA
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State | PR
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Zip | 00784
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Country | US
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Telephone | 787-202-6833
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3083
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City | GUAYAMA
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State | PR
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Zip | 00785-3083
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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 | KAMELIA LYDMAR BAEZ SOLIER
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Credential |
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Telephone | 787-202-6833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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