Healthcare Provider Details

I. General information

NPI: 1902433113
Provider Name (Legal Business Name): COCO SALUD VISUAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 11/27/2023
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 AVE HOSTOS STE 1
MAYAGUEZ PR
00682-6326
US

IV. Provider business mailing address

27 VILLA BENNY
MAYAGUEZ PR
00680-7118
US

V. Phone/Fax

Practice location:
  • Phone: 787-645-0897
  • Fax:
Mailing address:
  • Phone: 787-645-0897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BETSY G COLON-ACEVEDO
Title or Position: MD/OWNER
Credential: MD
Phone: 787-645-0897