Healthcare Provider Details

I. General information

NPI: 1427476878
Provider Name (Legal Business Name): OJITOS OFTALMOLOGIA PEDIATRICA CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CALLE HERNANDEZ CARRION STE 4301
MANATI PR
00674-4689
US

IV. Provider business mailing address

200 CALLE HERNANDEZ CARRION STE 4301
MANATI PR
00674-4689
US

V. Phone/Fax

Practice location:
  • Phone: 939-440-9200
  • Fax: 939-440-9222
Mailing address:
  • Phone: 939-440-9200
  • Fax: 939-440-9222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number15390
License Number StatePR

VII. Legacy identifiers

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

# 1
Identifier1164670980
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerNPPES

VIII. Authorized Official

Name: MR. ROBERTO RIVERA
Title or Position: SECRETARY
Credential:
Phone: 787-404-2427