Healthcare Provider Details

I. General information

NPI: 1952564643
Provider Name (Legal Business Name): DR.OSCAR MUNIZ LUCIANO MAXILLOFACIAL SURGERY PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 CALLE DR NELSON PEREA DOCTORS CENTER BUILDING SUITE 206
MAYAGUEZ PR
00680-4949
US

IV. Provider business mailing address

27 CALLE DR NELSON PEREA DOCTORS CENTER BUILDING SUITE 206
MAYAGUEZ PR
00680-4949
US

V. Phone/Fax

Practice location:
  • Phone: 178-783-3121
  • Fax: 178-726-5058
Mailing address:
  • Phone: 178-783-3121
  • Fax: 178-726-5058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2147
License Number StatePR

VIII. Authorized Official

Name: DR. OSCAR MUNIZ LUCIANO
Title or Position: PRESIDENT
Credential: D.M.D., M.D.
Phone: 17878331215