Healthcare Provider Details

I. General information

NPI: 1134893373
Provider Name (Legal Business Name): TESSIE HARFUCH CAPDEVILA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/02/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF PUERTO RICO, MEDICAL SCIENCES CAMPUS PASEO DR. JOSE CELSO BARBOSA
SAN JUAN PR
00921-0092
US

IV. Provider business mailing address

1093 CALLE 1
SAN JUAN PR
00927-5128
US

V. Phone/Fax

Practice location:
  • Phone: 787-484-5860
  • Fax:
Mailing address:
  • Phone: 787-484-3830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number070-R
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: