Healthcare Provider Details

I. General information

NPI: 1073659397
Provider Name (Legal Business Name): DR. TOMAS DEYNES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 CALLE PAVIA FERNANDEZ
SAN SEBASTIAN PR
00685-2285
US

IV. Provider business mailing address

PO BOX 1537
SAN SEBASTIAN PR
00685-1537
US

V. Phone/Fax

Practice location:
  • Phone: 787-280-3553
  • Fax: 787-896-0709
Mailing address:
  • Phone: 787-280-1335
  • Fax: 787-896-0709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5689
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: