Healthcare Provider Details

I. General information

NPI: 1942264973
Provider Name (Legal Business Name): DR. PILAR BULTED
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDIFICIO PONCE DARLINGTON CALLE MARINA SUITE 1 A
PONCE PR
00717-1528
US

IV. Provider business mailing address

2173 CALLE TRIGO ESTANCIAS DEL CARMEN
PONCE PR
00716-2226
US

V. Phone/Fax

Practice location:
  • Phone: 787-259-9537
  • Fax:
Mailing address:
  • Phone: 787-259-9537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number15285
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: