Healthcare Provider Details

I. General information

NPI: 1649485657
Provider Name (Legal Business Name): SOC DRES ATILANO LEON, JOSE A MORALES, EDGAR ECHEVARRIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 CALLE NAPOLES STE 208 CONCORDIA GARDENS SHOPPING CTR
RIO PIEDRAS PR
00924-4605
US

IV. Provider business mailing address

PO BOX 29736
SAN JUAN PR
00929-0736
US

V. Phone/Fax

Practice location:
  • Phone: 787-755-4347
  • Fax: 787-283-7440
Mailing address:
  • Phone: 787-755-4347
  • Fax: 787-283-7440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StatePR

VIII. Authorized Official

Name: MS. EMMA GISELA MONTANEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-374-1181