Provider Demographics
NPI:1306223797
Name:M.C.M ULCER CARE
Entity Type:Organization
Organization Name:M.C.M ULCER CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENFERMERA GENERALITA
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:CRUZ
Authorized Official - Last Name:MONTALVO
Authorized Official - Suffix:
Authorized Official - Credentials:BACHILLERATO
Authorized Official - Phone:787-202-1357
Mailing Address - Street 1:HC 3 BOX 32695
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-9764
Mailing Address - Country:US
Mailing Address - Phone:787-202-1357
Mailing Address - Fax:
Practice Address - Street 1:HC 3 BOX 32695
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-9764
Practice Address - Country:US
Practice Address - Phone:787-202-1357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR73498320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities