Healthcare Provider Details

I. General information

NPI: 1730046475
Provider Name (Legal Business Name): MR. JOSE ANTONIO ARACENA SENIOR SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 PR-696
DORADO PR
00646
US

IV. Provider business mailing address

A1 CALLE AIDA
SAN JUAN PR
00926-4254
US

V. Phone/Fax

Practice location:
  • Phone: 787-625-5050
  • Fax:
Mailing address:
  • Phone: 412-614-1637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number17677I
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: