=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811541360
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MACRO HEALTH CARE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2019
-----------------------------------------------------
Last Update Date | 08/01/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CALLE ESTEBAN QUINTANA CARR 2
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00966-0096
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-915-3030
-----------------------------------------------------
Fax | 866-342-0003
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1005 CARRETERA 2
-----------------------------------------------------
City | BAYAMON
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-915-3030
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MANUEL AGOSTO
-----------------------------------------------------
Credential | MBMF
-----------------------------------------------------
Telephone | 787-270-2027
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------