Healthcare Provider Details

I. General information

NPI: 1184068843
Provider Name (Legal Business Name): PONCE PAIN DOC., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 PASEO LAS MONJITAS SUITE159
PONCE PR
00730-4220
US

IV. Provider business mailing address

1255 PASEO LAS MONJITAS SUITE159
PONCE PR
00730-4220
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-1818
  • Fax:
Mailing address:
  • Phone: 787-840-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. ALBERTO RIVERA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-709-0574