Healthcare Provider Details

I. General information

NPI: 1770932857
Provider Name (Legal Business Name): CENTRO NEUMOLOGICO DE HUMACAO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 CALLE FONT MARTELO URB EL RECREO
HUMACAO PR
00791-3345
US

IV. Provider business mailing address

PO BOX 9290
HUMACAO PR
00792-9290
US

V. Phone/Fax

Practice location:
  • Phone: 787-474-0406
  • Fax:
Mailing address:
  • Phone: 787-474-0406
  • Fax: 787-719-5200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number13413
License Number StatePR

VIII. Authorized Official

Name: DR. LUIS C TORRELLAS RUIZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-474-0406