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General NPI Number Information
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NPI Number | 1700479615
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Entity Type | Organization
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Legal Business Name | MAGNIFICA HOMEHEALTH SUPPORT
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Dates
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Enumeration Date | 02/11/2021
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Last Update Date | 02/11/2021
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Provider Practice Location Address
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Address Line | D3 CALLE AMARANTA
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City | PONCE
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State | PR
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Zip | 00716-4022
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Country | US
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Telephone | 939-777-2425
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 371
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City | MERCEDITA
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State | PR
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Zip | 00715-0371
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Country | US
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Telephone | 939-777-2425
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Fax |
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Authorized Official
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Title or Position | HEALTHCARE ADMINISTRATOR
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Name | WALESKA LOPEZ
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Credential | RN,MBA
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Telephone | 939-777-2425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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