Healthcare Provider Details

I. General information

NPI: 1275177990
Provider Name (Legal Business Name): JORGE GALIBER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 CALLE SAN FELIPE
ARECIBO PR
00612-4680
US

IV. Provider business mailing address

PO BOX 580
ARECIBO PR
00613-0580
US

V. Phone/Fax

Practice location:
  • Phone: 787-879-1769
  • Fax:
Mailing address:
  • Phone: 787-879-1769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: