Healthcare Provider Details

I. General information

NPI: 1922556661
Provider Name (Legal Business Name): ECB PONCE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 CALLE UNION SUITE 129
PONCE PR
00730-3686
US

IV. Provider business mailing address

83 CALLE UNION SUITE 129
PONCE PR
00730-3686
US

V. Phone/Fax

Practice location:
  • Phone: 787-812-4444
  • Fax:
Mailing address:
  • Phone: 787-812-4444
  • Fax: 787-813-0843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number276
License Number StatePR

VIII. Authorized Official

Name: DR. RAFAEL SANTOS
Title or Position: CEO
Credential: MD
Phone: 787-812-4444