Healthcare Provider Details

I. General information

NPI: 1497481469
Provider Name (Legal Business Name): WOMEN'S HEALTH AND AESTHETIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 08/01/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. #2 BARRIO COTTO NORTE KM 47.4 OFICINA #2-07 EDIFICIO MEDICO PEDRO BLANCO LUGO
MANATI PR
00674
US

IV. Provider business mailing address

PO BOX 2012
MANATI PR
00674-2012
US

V. Phone/Fax

Practice location:
  • Phone: 787-236-9496
  • Fax:
Mailing address:
  • Phone: 787-236-9496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. RAUL F PENA VALDIVIA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-236-9496