MEDICARE: PROVIDERS CARE NETWORK 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1649753823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVIDERS CARE NETWORK INC.

Provider Business Mailing Address
First Line	:	1605 AVE PONCE DE LEON STE 600
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00909-1813
Country	:	US
Telephone Number	:	787-643-0153
Fax Number	:

Provider Business Practice Location Address
First Line	:	1605 AVE PONCE DE LEON STE 600
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00909-1813
Country	:	US
Telephone Number	:	787-643-0153
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOSE ESPARRA
Credential	:
Telephone Number	:	787-643-0153

Provider Enumeration Date	:	09/13/2018
Last Update Date	:	09/13/2018

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