Healthcare Provider Details

I. General information

NPI: 1194251512
Provider Name (Legal Business Name): ENDOHEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 BS AVE LAS AMERICAS URB BAIROA
CAGUAS PR
00725
US

IV. Provider business mailing address

1575 AVE MUNOZ RIVERA PMB 121
PONCE PR
00717-0211
US

V. Phone/Fax

Practice location:
  • Phone: 787-974-7868
  • Fax:
Mailing address:
  • Phone: 787-974-7868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number18803
License Number StatePR

VIII. Authorized Official

Name: VIVIANA M ORTIZ-SANTIAGO
Title or Position: SOLE MEMBER
Credential:
Phone: 787-974-7868