Provider Demographics
NPI:1174404669
Name:PUEBLO CARE NY LLC
Entity type:Organization
Organization Name:PUEBLO CARE NY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:R
Authorized Official - Last Name:ANGLADA CORTES
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:720-761-1362
Mailing Address - Street 1:333 W COMMERCIAL ST FL 3
Mailing Address - Street 2:
Mailing Address - City:EAST ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14445-2400
Mailing Address - Country:US
Mailing Address - Phone:315-353-9191
Mailing Address - Fax:
Practice Address - Street 1:333 W COMMERCIAL ST FL 3
Practice Address - Street 2:
Practice Address - City:EAST ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14445-2400
Practice Address - Country:US
Practice Address - Phone:315-353-9191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty