Healthcare Provider Details

I. General information

NPI: 1124533468
Provider Name (Legal Business Name): CENTRO ORTODONTICO DRA. ANNELISSE FIGUEROA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2017
Last Update Date: 12/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 URB GOMEZ
HUMACAO PR
00791-4224
US

IV. Provider business mailing address

6 URB GOMEZ
HUMACAO PR
00791-4224
US

V. Phone/Fax

Practice location:
  • Phone: 787-852-1550
  • Fax: 787-852-6798
Mailing address:
  • Phone: 787-852-1550
  • Fax: 787-852-6798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StatePR

VIII. Authorized Official

Name: DR. RUBEN CHAMORRO
Title or Position: PRESIDENT
Credential: DMD
Phone: 787-852-1550