MEDICARE: PROFESSIONAL HEALTH CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		PR

General Provider Information

NPI Number	:	1174525398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL HEALTH CARE

Provider Business Mailing Address
First Line	:	PO BOX 145
Second Line	:
City	:	AGUADA
State	:	PR
Zip	:	00602-0145
Country	:	US
Telephone Number	:	787-252-3945
Fax Number	:	787-252-3940

Provider Business Practice Location Address
First Line	:	CALLE COLON 131
Second Line	:
City	:	AGUADA
State	:	PR
Zip	:	00602
Country	:	US
Telephone Number	:	787-252-9345
Fax Number	:	787-252-3940

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. DAMARIS MATOS
Credential	:
Telephone Number	:	787-252-3945

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	08/22/2020

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