Organization Name: | TRANSFORMA MEDICAL MALL CORP. |
NPI Number: | 1194960773 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ISMAEL MERCADO (CEO) |
Mailing Address: | Calle 2 G-14 Urb. Villa Rica Bayamon |
State: | PR US |
Postal Code: | 00959 |
Phone Number: | 7877854402 |
Fax Number: | 7879950283 |
NPI Enumeration Date: | 12/10/2008 |
NPI Last Update Date: | 12/10/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |