# MEDWELL MEDICAL MANAGEMENT CORP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942054614
- **Authorized official:** MRS. SONIA IVELISSE BONILLA RN (PRESIDENT)
- **Authorized official phone:** (787) 599-5010

## Contact information

- **Practice address:** 8169 CALLE CONCORDIA STE 310, PONCE, PR 00717-1563
- **Practice address phone:** (787) 599-5010
- **Practice address fax:** (787) 437-3636
- **Mailing address:** 8169 CALLE CONCORDIA STE 310, PONCE, PR 00717-1563
- **Mailing address phone:** (787) 599-5010
- **Mailing address fax:** (787) 437-3636

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | — |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |
| 302R00000X | Health Maintenance Organization | — | NULL | Yes |

## Other

- **Enumeration date:** 04/17/2024
- **Last updated:** 04/17/2024