Healthcare Provider Details

I. General information

NPI: 1255668828
Provider Name (Legal Business Name): OPTIMUS AETAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2009
Last Update Date: 11/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 CALLE SERGIO CUEVAS 4TO PISO
SAN JUAN PR
00918-2683
US

IV. Provider business mailing address

429 CALLE SAN GENARO SAGRADO CORAZON
SAN JUAN PR
00926-4221
US

V. Phone/Fax

Practice location:
  • Phone: 787-474-7629
  • Fax:
Mailing address:
  • Phone: 787-319-9226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RUTH A SANTOS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-474-7629