Healthcare Provider Details

I. General information

NPI: 1912132531
Provider Name (Legal Business Name): RETINA SPECIALISTS OF PUERTO RICO, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 05/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 CALLE COLA DE PESCADO
GUAYNABO PR
00969-5818
US

IV. Provider business mailing address

35 CALLE JUAN C BORBON STE 67-333
GUAYNABO PR
00969-5374
US

V. Phone/Fax

Practice location:
  • Phone: 787-955-5051
  • Fax:
Mailing address:
  • Phone: 787-955-5051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number16089
License Number StatePR

VIII. Authorized Official

Name: SARAH M ACEVEDO
Title or Position: PRESIDENT
Credential: MD
Phone: 787-955-5051