Healthcare Provider Details

I. General information

NPI: 1972284552
Provider Name (Legal Business Name): ECB HUMACAO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 07/27/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RIO GRANDE TOWN CENTER CARR 3 SUITE A-19
RIO GRANDE PR
00745
US

IV. Provider business mailing address

RIO GRANDE TOWN CENTER CARR 3 SUITE A-19
RIO GRANDE PR
00745
US

V. Phone/Fax

Practice location:
  • Phone: 787-988-7061
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MR. GABRIEL SANTOS
Title or Position: OPTOMETRIST
Credential: OD
Phone: 787-239-0468