Healthcare Provider Details

I. General information

NPI: 1285041525
Provider Name (Legal Business Name): NUMENDO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 07/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#348 CAMINO DEL CUPEY SABANERA DORADO
DORADO PR
00646
US

IV. Provider business mailing address

#348 CAMINO DEL CUPEY SABANERA DORADO
DORADO PR
00646
US

V. Phone/Fax

Practice location:
  • Phone: 787-360-6778
  • Fax:
Mailing address:
  • Phone: 787-360-6778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number17901
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number17821
License Number StatePR

VIII. Authorized Official

Name: DR. CARLOS JAVIER MONTALVAN-MIRO
Title or Position: PRESIDENT
Credential: MD
Phone: 787-360-6778