Provider Demographics
NPI:1811035223
Name:INNOVATIVE CARE PSC
Entity Type:Organization
Organization Name:INNOVATIVE CARE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO MALAVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-786-4615
Mailing Address - Street 1:112 CALLE OVIEDO
Mailing Address - Street 2:CIUDAD JARDIN BAIROA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-1344
Mailing Address - Country:US
Mailing Address - Phone:787-703-6273
Mailing Address - Fax:
Practice Address - Street 1:AA1 CALLE 5
Practice Address - Street 2:REPARTO VALENCIA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-3719
Practice Address - Country:US
Practice Address - Phone:787-786-4615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8204174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty