Healthcare Provider Details

I. General information

NPI: 1396292603
Provider Name (Legal Business Name): RUBEN ANTONIO JESUS TRESGALLO PARES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2016
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6110
US

IV. Provider business mailing address

1353 CALLE 19 PMB 192
GUAYNABO PR
00966-2700
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-5622
  • Fax:
Mailing address:
  • Phone: 787-921-2050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberA184415
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number21777
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number1019486
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: