Healthcare Provider Details

I. General information

NPI: 1346834355
Provider Name (Legal Business Name): VILLA TOLEDO CENTRO DE REHABILITACION E IMPLANTOLOGIA ORAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 02/22/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO HATO ARRIBA CARR 129 KM 5-2 BLDG
ARECIBO PR
00612
US

IV. Provider business mailing address

PO BOX 140068
ARECIBO PR
00614-0068
US

V. Phone/Fax

Practice location:
  • Phone: 787-816-1041
  • Fax:
Mailing address:
  • Phone: 787-241-3634
  • 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: RAFAEL E SUAREZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-241-3634