Provider Demographics
NPI:1760709059
Name:HYPERBARIC AND WOUND CARE CENTER OF PUERTO RICO
Entity Type:Organization
Organization Name:HYPERBARIC AND WOUND CARE CENTER OF PUERTO RICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIEZER
Authorized Official - Middle Name:SOSA
Authorized Official - Last Name:FARIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-832-0653
Mailing Address - Street 1:15 LUIS F. DE JESUS
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795
Mailing Address - Country:US
Mailing Address - Phone:787-832-0653
Mailing Address - Fax:787-831-0266
Practice Address - Street 1:AVE. HOSTOS #410, CARR 2
Practice Address - Street 2:CENTRO MEDICO DE MAYAGUEZ, PRIMER PISO SUITE 1
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00660
Practice Address - Country:US
Practice Address - Phone:787-832-0653
Practice Address - Fax:787-831-0266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR014191208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR99567Medicare UPIN