Provider Demographics
NPI:1417367681
Name:NANCY WILLIAMS MALTES PSC
Entity Type:Organization
Organization Name:NANCY WILLIAMS MALTES PSC
Other - Org Name:LABORATORIO CLINICO WILLIAMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-848-0405
Mailing Address - Street 1:PO BOX 10038
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-0038
Mailing Address - Country:US
Mailing Address - Phone:787-848-0405
Mailing Address - Fax:787-290-3535
Practice Address - Street 1:1128 AVE MUNOZ RIVERA
Practice Address - Street 2:RPTO. UNIVERSITARIO
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0643
Practice Address - Country:US
Practice Address - Phone:787-848-0405
Practice Address - Fax:787-290-3535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-28
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR704291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
7310078OtherHUMANA
PR3099OtherIMC
PR660423616OtherHUMANA GOLD PLAN
800218OtherMMM
PR30579OtherSSS
400305OtherPREFERRED HEALTH PLAN
PR0038188Medicare PIN