Healthcare Provider Details

I. General information

NPI: 1982908240
Provider Name (Legal Business Name): TAHIMY ORTIZ NIEVES DBA SPECIAL BREAST BOUTIQUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2010
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AGUAS BUENAS ST. #19 URB. BONNEVILLE HEIGHTS
CAGUAS PR
00727-4939
US

IV. Provider business mailing address

AGUAS BUENAS ST. #19 URB. BONNEVILLE HEIGHTS
CAGUAS PR
00727-4939
US

V. Phone/Fax

Practice location:
  • Phone: 787-743-9977
  • Fax: 787-744-8733
Mailing address:
  • Phone: 787-743-9977
  • Fax: 787-744-8733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: TAHIMY ORTIZ
Title or Position: OWNER
Credential:
Phone: 787-743-9977