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General NPI Number Information
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NPI Number | 1811035223
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Entity Type | Organization
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Legal Business Name | INNOVATIVE CARE PSC
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | AA1 CALLE 5 REPARTO VALENCIA
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City | BAYAMON
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State | PR
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Zip | 00959-3719
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Country | US
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Telephone | 787-786-4615
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Fax |
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Provider Business Mailing Address
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Address Line | 112 CALLE OVIEDO CIUDAD JARDIN BAIROA
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City | CAGUAS
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State | PR
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Zip | 00727-1344
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Country | US
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Telephone | 787-703-6273
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. RUTH SOTO MALAVE
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Credential | M.D.
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Telephone | 787-786-4615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 8204
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License Number State | PR
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