Provider Demographics
NPI:1710737994
Name:PUERTO RICO CASE MANEGEMENT CORP
Entity Type:Organization
Organization Name:PUERTO RICO CASE MANEGEMENT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADOR
Authorized Official - Prefix:
Authorized Official - First Name:GISSELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BENITEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-358-0381
Mailing Address - Street 1:540 CARR 169 APT 1006 BALCONES DE GUAYNABO
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-358-0381
Mailing Address - Fax:
Practice Address - Street 1:140 AVENIDA LAS CUMBRES GUAYNABO MEDICAL MALL
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-358-0381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PUERTO RICO CASE MANEGEMENT CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology