Healthcare Provider Details

I. General information

NPI: 1376470450
Provider Name (Legal Business Name): PR SURGICAL ENDOSCOPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

QUADRANGLE MEDICAL CENTER SUITE 205 AVE LUIS MUNOZ MARIN
CAGUAS PR
00725
US

IV. Provider business mailing address

RIVERSIDE PARK CALLE 7 F26
BAYAMON PR
00961
US

V. Phone/Fax

Practice location:
  • Phone: 787-215-7012
  • Fax:
Mailing address:
  • Phone: 787-215-7012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: EMANUEL A DE MIRANDA-SANCHEZ
Title or Position: MEMBER
Credential: MD
Phone: 787-215-7012