Provider Demographics
NPI:1497837215
Name:MEDICAL COMMNAD PRNG
Entity Type:Organization
Organization Name:MEDICAL COMMNAD PRNG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL SUGICAL NURSE
Authorized Official - Prefix:
Authorized Official - First Name:OSVALDO
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, MPH
Authorized Official - Phone:787-774-3344
Mailing Address - Street 1:URB ESTANCIA LA TRINITARIA GERANIO # 896
Mailing Address - Street 2:
Mailing Address - City:AGUIRRE
Mailing Address - State:PR
Mailing Address - Zip Code:00704
Mailing Address - Country:US
Mailing Address - Phone:787-774-3344
Mailing Address - Fax:787-774-6250
Practice Address - Street 1:URB ESTANCIA LA TRINITARIA GERANIO # 896
Practice Address - Street 2:
Practice Address - City:AGUIRRE
Practice Address - State:PR
Practice Address - Zip Code:00704
Practice Address - Country:US
Practice Address - Phone:787-774-3344
Practice Address - Fax:787-774-6250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12850314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility