Provider Demographics
NPI:1497150320
Name:MARALANA CSP
Entity Type:Organization
Organization Name:MARALANA CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:WISCOVITCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-259-5990
Mailing Address - Street 1:PO BOX 7122
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7122
Mailing Address - Country:US
Mailing Address - Phone:787-259-5990
Mailing Address - Fax:787-259-5990
Practice Address - Street 1:1910 AVE LAS AMERICAS
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-2813
Practice Address - Country:US
Practice Address - Phone:787-259-5990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9858174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1942OtherPREFERRED MEDICAL CHOICE
PR582987239OtherMAPFRE INSURANCE
PR0400850OtherHUMANA INSURANCE
PR582987239OtherMEDICAL CARD SYSTEM
PR200194OtherMEDICARE Y MUCHO MAS
PR582987239OtherMCS CLASSICARE
PR41675OtherPROSSAM
PR582987239OtherMAPFRE MEDICARE
PR582987239OtherHUMANA GOLD PLUS
PR000041OtherAMERICAN HEALTH MEDICARE
PR3158OtherIMC
WI582987239OtherTRICARE
CO582987239OtherCHAMPUS VA
PR82569OtherTRIPLE S
PR582987239OtherFIRST PLUS
GA582987239OtherUNITED HEALTHCARE
PRPE3364OtherPALIC
WI582987239OtherTRICARE