Healthcare Provider Details

I. General information

NPI: 1922712413
Provider Name (Legal Business Name): GUAYNABO VASCULAR SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 AVE LAS CUMBRES
GUAYNABO PR
00969-4832
US

IV. Provider business mailing address

PO BOX 1239
GUAYNABO PR
00970-1239
US

V. Phone/Fax

Practice location:
  • Phone: 787-356-3791
  • Fax:
Mailing address:
  • Phone: 787-356-3791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LEONARDO VALENTIN
Title or Position: PRESIDENT
Credential: MD, DABR
Phone: 787-356-3791