Healthcare Provider Details

I. General information

NPI: 1942895529
Provider Name (Legal Business Name): GALERIA VEINTE VEINTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 03/04/2021
Certification Date: 02/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MARGINAL CARR. 100, KM 5.8
CABO ROJO PR
00623
US

IV. Provider business mailing address

PO BOX 1192
HORMIGUEROS PR
00660-1192
US

V. Phone/Fax

Practice location:
  • Phone: 787-235-2240
  • Fax:
Mailing address:
  • Phone: 787-235-2240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DANICA ORTIZ
Title or Position: PRESIDENT/OPTOMETRIST
Credential: O.D.
Phone: 787-235-2240