Provider Demographics
NPI:1205325776
Name:KIDNEY CARE LLC
Entity type:Organization
Organization Name:KIDNEY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:CORTES-SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-420-0417
Mailing Address - Street 1:H24 YAGRUMO
Mailing Address - Street 2:URB CAPARRA HILLS
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-3124
Mailing Address - Country:US
Mailing Address - Phone:787-420-0417
Mailing Address - Fax:
Practice Address - Street 1:735 AVENIDA PONCE DE LEON
Practice Address - Street 2:SUITE 814
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-764-8520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18681207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty