Healthcare Provider Details

I. General information

NPI: 1205921053
Provider Name (Legal Business Name): LYDIA ARILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 AVE FD ROOSEVELT OFF. 506
SAN JUAN PR
00918-2103
US

IV. Provider business mailing address

400 AVE FD ROOSEVELT OFF. 506
SAN JUAN PR
00918-2103
US

V. Phone/Fax

Practice location:
  • Phone: 787-250-0907
  • Fax: 787-756-5704
Mailing address:
  • Phone: 787-250-0907
  • Fax: 787-756-5704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2143
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: