Healthcare Provider Details

I. General information

NPI: 1962472845
Provider Name (Legal Business Name): CENTRO DE CIRUGIA AMBULATORIA LASER MEDICO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL OPHTHALMIC PLAZA 1875 CARR 2 SUITE 303
BAYAMON PR
00959-7217
US

IV. Provider business mailing address

MEDICAL OPHTHALMIC PLAZA 1875 CARR 2 SUITE 303
BAYAMON PR
00959-7217
US

V. Phone/Fax

Practice location:
  • Phone: 787-780-0404
  • Fax: 787-780-0411
Mailing address:
  • Phone: 787-780-0404
  • Fax: 787-780-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number3 CNC 97 206
License Number StatePR

VIII. Authorized Official

Name: DR. MARCEL P TOLLINCHE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-780-0404