Healthcare Provider Details

I. General information

NPI: 1366625592
Provider Name (Legal Business Name): GUAYNABO EYE & EAR GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 AVE ORTEGON SUITE 301
GUAYNABO PR
00966-2515
US

IV. Provider business mailing address

PO BOX 1036
GUAYNABO PR
00970-1036
US

V. Phone/Fax

Practice location:
  • Phone: 787-706-4334
  • Fax: 787-749-0993
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RAMON R. BERRIOS
Title or Position: OWNER
Credential: M.D.
Phone: 787-706-4334