Healthcare Provider Details

I. General information

NPI: 1679299341
Provider Name (Legal Business Name): ECB PLAZA LAS AMERICAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2022
Last Update Date: 10/14/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE ROOSEVELT 525 LOCAL 560
SAN JUAN PR
00730
US

IV. Provider business mailing address

GALERIAS PONCENAS MALL CALLE UNION 83 SUITE 129
PONCE PR
00730
US

V. Phone/Fax

Practice location:
  • Phone: 787-759-4444
  • Fax:
Mailing address:
  • Phone: 787-844-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. HEILEN M DE LA HOZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-643-9250