Healthcare Provider Details

I. General information

NPI: 1447154141
Provider Name (Legal Business Name): TQLL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

D1 CALLE CARACOL
CABO ROJO PR
00623
US

IV. Provider business mailing address

134 CALLE CARACOL 134 CALLE CARACOL
CABO ROJO PR
00623-3186
US

V. Phone/Fax

Practice location:
  • Phone: 787-612-9700
  • Fax:
Mailing address:
  • Phone: 787-612-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: FERNANDO LUIS PADILLA
Title or Position: OPTOMETRIST
Credential: OD
Phone: 787-612-9700