Healthcare Provider Details

I. General information

NPI: 1609105360
Provider Name (Legal Business Name): MR. MANUEL ALBERTORIO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URBANIZACION SANTA RITA 2 1069 CALLE SANTA JUANA
JUANA DIAZ PR
00795
US

IV. Provider business mailing address

URBANIZACION SANTA RITA 2 1069 CALLE SANTA JUANA
COTO LAUREL PUERTO RICO
00780 2883
UM

V. Phone/Fax

Practice location:
  • Phone: 787-677-2204
  • Fax:
Mailing address:
  • Phone: 787-677-2204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347B00000X
TaxonomyBus
License Number1911320
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: