Healthcare Provider Details

I. General information

NPI: 1699016295
Provider Name (Legal Business Name): LMA COSMETIC, ORAL AND MAXILLOFACIAL SURGERY SERVICES, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2013
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LAS CATALINAS MALL CARIBBEAN CINEMAS SUITE 205
CAGUAS PR
00725-5200
US

IV. Provider business mailing address

LAS CATALINAS MALL CARIBBEAN CINEMAS SUITE 205
CAGUAS PR
00725-5200
US

V. Phone/Fax

Practice location:
  • Phone: 787-961-8090
  • Fax: 787-961-8099
Mailing address:
  • Phone: 787-961-8090
  • Fax: 787-961-8099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number2673
License Number StatePR

VIII. Authorized Official

Name: DR. LIS M AROCHO
Title or Position: PRESIDENT
Credential: DMD
Phone: 787-346-3844