Healthcare Provider Details

I. General information

NPI: 1275637456
Provider Name (Legal Business Name): ENID SANTOS CINTRON GENERAL MEDICINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C17 CALLE ALBARROBA URB SANTA ELENA
GUAYANILLA PR
00656
US

IV. Provider business mailing address

C17 CALLE ALBARROBA URB SANTA ELENA
GUAYANILLA PR
00656
US

V. Phone/Fax

Practice location:
  • Phone: 787-835-4574
  • Fax: 787-927-7010
Mailing address:
  • Phone: 787-835-4574
  • Fax: 787-927-7010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number16040
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: