Healthcare Provider Details

I. General information

NPI: 1861403966
Provider Name (Legal Business Name): DR. ROSA ELENA CANTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 09/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2363 AVE LAS AMERICAS
PONCE PR
00717-0776
US

IV. Provider business mailing address

RR 36 BOX 1363
SAN JUAN PR
00926-9704
US

V. Phone/Fax

Practice location:
  • Phone: 787-284-0000
  • Fax: 787-841-0943
Mailing address:
  • Phone: 787-761-0892
  • Fax: 787-760-7056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2612
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: