Healthcare Provider Details

I. General information

NPI: 1407091036
Provider Name (Legal Business Name): CENTRO DE ENDOSCOPIA AVANZADA DEL CARIBE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 12/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DE DIEGO ST. 55 EAST CPR PROFESSIONAL BLDG. SUITE 104
MAYAGUEZ PR
00681
US

IV. Provider business mailing address

PO BOX 3146
MAYAGUEZ PR
00681-3146
US

V. Phone/Fax

Practice location:
  • Phone: 787-265-4250
  • Fax: 787-265-4290
Mailing address:
  • Phone: 787-265-4250
  • Fax: 787-265-4290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. FRANCISCO C CEBOLLERO
Title or Position: PRESIDENT
Credential: MD
Phone: 787-265-4250