Healthcare Provider Details

I. General information

NPI: 1518003276
Provider Name (Legal Business Name): PUVA-TEK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

978 CALLE 42 SE REPARTO METROPOLITANO
SAN JUAN PR
00921-2701
US

IV. Provider business mailing address

978 CALLE 42 SE REPARTO METROPOLITANO
SAN JUAN PR
00921-2701
US

V. Phone/Fax

Practice location:
  • Phone: 787-753-3734
  • Fax: 787-753-3734
Mailing address:
  • Phone: 787-753-3734
  • Fax: 787-753-3734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERTO E ALFONSO
Title or Position: PRESIDENT
Credential: MD
Phone: 787-753-3734