Healthcare Provider Details

I. General information

NPI: 1114542016
Provider Name (Legal Business Name): PREFERRED PODIATRY NETWORK OF PUERTO RICO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PASEO SAN PABLO EDIF DR. ARTURO CADILLA OFIC 409
BAYAMON PR
00961
US

IV. Provider business mailing address

100 PASEO SAN PABLO EDIF DR. ARTURO CADILLA OFIC 409
BAYAMON PR
00961
US

V. Phone/Fax

Practice location:
  • Phone: 787-435-2292
  • Fax:
Mailing address:
  • Phone: 787-435-2292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOAQUIN BALAGUER
Title or Position: PRESIDENT
Credential: MC
Phone: 787-435-2292