Healthcare Provider Details

I. General information

NPI: 1164237269
Provider Name (Legal Business Name): ECB HUMACAO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 02/07/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZA CENTRO MALL AVE RAFAEL CORDERO ESQUINA PR 30 LOCAL#10
CAGUAS PR
00725
US

IV. Provider business mailing address

PLAZA FAJARDO CARR 3 SUITE 125
FAJARDO PR
00738
US

V. Phone/Fax

Practice location:
  • Phone: 787-801-5896
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: GABRIEL SANTOS
Title or Position: PRESIDENT
Credential:
Phone: 787-801-5896