Healthcare Provider Details

I. General information

NPI: 1053635995
Provider Name (Legal Business Name): OJOS PUERTO RICO ADMINISTRACION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2010
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 AVE MUNOZ RIVERA E P1 A1 SUITE 1
CAMUY PR
00627-2630
US

IV. Provider business mailing address

300 AVE LA SIERRA APT 101
SAN JUAN PR
00926-4339
US

V. Phone/Fax

Practice location:
  • Phone: 787-403-2791
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number15856
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15856
License Number StatePR

VIII. Authorized Official

Name: OSCAR ALEJANDRO HERNANDEZ
Title or Position: CEO
Credential: MD
Phone: 787-403-2791