| NPI | 1912901489 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARISEL RIVERA Owner 787-833-1870 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: PR 5140390001) |
| Enumeration Date | 2005-06-12 |
| Last Update Date | 2020-08-22 |