Healthcare Provider Details

I. General information

NPI: 1982958773
Provider Name (Legal Business Name): RETINA CARE PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 CALLE PONCE DE LEON URB. GARCIA
ARECIBO PR
00612-4315
US

IV. Provider business mailing address

PO BOX 2770
ARECIBO PR
00613-2770
US

V. Phone/Fax

Practice location:
  • Phone: 787-680-7222
  • Fax: 787-680-7223
Mailing address:
  • Phone: 787-680-7222
  • Fax: 787-680-7223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number16978
License Number StatePR

VIII. Authorized Official

Name: DR. ANDRES EMANUELLI ANZALOTTA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-680-7222