Healthcare Provider Details

I. General information

NPI: 1689451361
Provider Name (Legal Business Name): DAPHNE CHARLES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 09/14/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY #2, KM. 80.4, BARRIO SAN DANIEL, SECTOR LAS CAN
ARECIBO PR
00614-4050
US

IV. Provider business mailing address

HIGHWAY #2, KM. 80.4, BARRIO SAN DANIEL, SECTOR LAS CAN PO BOX 4050
ARECIBO PR
00614-4050
US

V. Phone/Fax

Practice location:
  • Phone: 787-878-5475
  • Fax:
Mailing address:
  • Phone: 787-878-5475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number817937
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: