Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Administrator |
163WA2000X | |||
Registered Nurse |
163W00000X |
| NPI # | 1912415258 |
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| LBN Legal business name | PRO HEALTH MANAGEMENT CARE LLC | ||||||||
| Authorized official | IVAN HERNANDEZ - (CEO) | ||||||||
| Entity | Organization | ||||||||
| Organization subpart 1 | No | ||||||||
| Enumeration date | 01/22/2018 | ||||||||
| Last updated | 01/22/2018 - About 8 years ago | ||||||||
| Identifiers |
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