Healthcare Provider Details

I. General information

NPI: 1306859541
Provider Name (Legal Business Name): DINAMICA QUIRURGICA DEL ESTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDIFICIO MEDICO DEL ESTE AVE. GENERAL VALERO
FAJARDO PR
00738-7005
US

IV. Provider business mailing address

PMB 265 PO BOX 70005
FAJARDO PR
00738-7005
US

V. Phone/Fax

Practice location:
  • Phone: 787-860-3386
  • Fax:
Mailing address:
  • Phone: 787-860-3386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11335
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number6201
License Number StatePR

VIII. Authorized Official

Name: MRS. YNGRID LITHGOW
Title or Position: PRESIDENT
Credential:
Phone: 787-860-3386