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General NPI Number Information
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NPI Number | 1922706605
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Entity Type | Organization
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Legal Business Name | FOREVER YOUNG LLC
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Dates
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Enumeration Date | 02/21/2023
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Last Update Date | 02/21/2023
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Provider Practice Location Address
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Address Line | BO. QUEBRADA LARGA CARR # 2 KM 142.2
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City | ANASCO
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State | PR
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Zip | 00610
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Country | US
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Telephone | 787-826-3636
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2093
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City | ANASCO
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State | PR
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Zip | 00610-2093
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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 | PRESIDENTE
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Name | DR. MARIBEL DUPONT
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Credential |
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Telephone | 787-509-8850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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