Provider Demographics
NPI:1669697652
Name:WOUND AND ULCER CARE CLINIC OF SAN
Entity type:Organization
Organization Name:WOUND AND ULCER CARE CLINIC OF SAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VELLEJO CARMONA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, CWS
Authorized Official - Phone:787-751-1110
Mailing Address - Street 1:AVE. DOMENECH 385
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-751-1110
Mailing Address - Fax:787-771-9715
Practice Address - Street 1:AVE. DOMENECH 385
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-751-1110
Practice Address - Fax:787-771-9715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty