Healthcare Provider Details

I. General information

NPI: 1659595676
Provider Name (Legal Business Name): METRO PAVIA HEALTHCARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 129 VICTOR ROJAS 2 ZONA INDUSTRIAL
ARECIBO PR
00613
US

IV. Provider business mailing address

PO BOX 9976 COTTO STATION
ARECIBO PR
00613-9976
US

V. Phone/Fax

Practice location:
  • Phone: 787-650-0020
  • Fax: 787-274-8895
Mailing address:
  • Phone: 787-650-0020
  • Fax: 787-274-8895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number2655
License Number StatePR

VIII. Authorized Official

Name: VIVIAN SOLIVAN
Title or Position: PRESIDENT
Credential:
Phone: 787-650-7294