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General NPI Number Information
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NPI Number | 1912415258
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Entity Type | Organization
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Legal Business Name | PRO HEALTH MANAGEMENT CARE LLC
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Dates
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Enumeration Date | 01/22/2018
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Last Update Date | 01/22/2018
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Provider Practice Location Address
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Address Line | PARQUE CENTRAL CALLE 65 V 12
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City | CAGUAS
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State | PR
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Zip | 00727
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Country | US
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Telephone | 787-341-1732
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Fax | 787-744-5993
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Provider Business Mailing Address
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Address Line | CALLE 65 V 12 PARQUE CENTRAL
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City | CAGUAS
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State | PR
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Zip | 00727
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Country | US
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Telephone | 787-341-1732
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Fax | 787-744-5993
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Authorized Official
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Title or Position | CEO
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Name | IVAN HERNANDEZ
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Credential | REGISTERED NURSE
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Telephone | 787-341-1732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9397537
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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License Number | 83591
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License Number State | PR
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