MEDICARE: WOUND CARE PLUS EDUCATION AND RESEARCH CENTER, INC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1194160754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOUND CARE PLUS EDUCATION AND RESEARCH CENTER, INC

Provider Business Mailing Address
First Line	:	PO BOX 194000
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00919-4000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	385 CALLE MANUEL DOMENECH
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3718
Country	:	US
Telephone Number	:	787-649-1928
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MISS LETICIA VALLEJO
Credential	:
Telephone Number	:	787-649-1928

Provider Enumeration Date	:	05/08/2013
Last Update Date	:	05/08/2013

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