Healthcare Provider Details

I. General information

NPI: 1659103885
Provider Name (Legal Business Name): ENDORAP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 08/16/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 167 KM 22.2 PLAZA TROPICAL #11
BAYAMON PR
00929
US

IV. Provider business mailing address

55 DE DIEGO ESTE SUITE 206
MAYAGUEZ PR
00680
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-1340
  • Fax:
Mailing address:
  • Phone: 787-641-1340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JUAN D RAMIREZ DE ARELLANO PONCE
Title or Position: PRESIDENT
Credential: DMD
Phone: 787-371-0209