Healthcare Provider Details

I. General information

NPI: 1275584708
Provider Name (Legal Business Name): OMAR J SILVA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 09/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CDT NAGUABO CARR 31 KM 4.0
NAGUABO PR
00718
US

IV. Provider business mailing address

URB SAN FERNANDO L 2 CALLE 9
BAYAMON PR
00957
US

V. Phone/Fax

Practice location:
  • Phone: 787-273-1227
  • Fax:
Mailing address:
  • Phone: 787-273-1227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13952
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: