Healthcare Provider Details

I. General information

NPI: 1245309665
Provider Name (Legal Business Name): ARARAT LIPODYSTROPHY CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8169 CALLE CONCORDIA STE 411 COND. SAN VICENTE
PONCE PR
00717-1567
US

IV. Provider business mailing address

8169 CALLE CONCORDIA STE 411 COND. SAN VICENTE
PONCE PR
00717-1567
US

V. Phone/Fax

Practice location:
  • Phone: 787-284-5884
  • Fax: 787-284-5874
Mailing address:
  • Phone: 787-284-5884
  • Fax: 787-284-5874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12061
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JUAN BAUTISTA RIVERA III
Title or Position: EXCECUTIVE DIRECTOS
Credential:
Phone: 787-284-5884