Provider Demographics
NPI:1942054614
Name:MEDWELL MEDICAL MANAGEMENT CORP
Entity Type:Organization
Organization Name:MEDWELL MEDICAL MANAGEMENT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:IVELISSE
Authorized Official - Last Name:BONILLA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:787-599-5010
Mailing Address - Street 1:8169 CALLE CONCORDIA STE 310
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1563
Mailing Address - Country:US
Mailing Address - Phone:787-599-5010
Mailing Address - Fax:787-437-3636
Practice Address - Street 1:8169 CALLE CONCORDIA STE 310
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1563
Practice Address - Country:US
Practice Address - Phone:787-599-5010
Practice Address - Fax:787-437-3636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care