MEDICARE: ECO CLEAN PR LLC

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	305R00000X	Preferred Provider Organization

General Provider Information

NPI Number	:	1295427409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ECO CLEAN PR LLC

Provider Business Mailing Address
First Line	:	575 CALLE DE DIEGO APT 510
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00924-3828
Country	:	US
Telephone Number	:	787-560-3151
Fax Number	:

Provider Business Practice Location Address
First Line	:	575 CALLE DE DIEGO APT 510
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00924-3828
Country	:	US
Telephone Number	:	787-560-3151
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MRS. SANDRA I. ROSA
Credential	:
Telephone Number	:	877-560-3151

Provider Enumeration Date	:	05/25/2023
Last Update Date	:	05/25/2023

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Directions to “ECO CLEAN PR LLC ” Practice Location

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