Healthcare Provider Details

I. General information

NPI: 1902859564
Provider Name (Legal Business Name): CENTRO DE ENFERMEDADES ALERGICAS Y AMBIENTALES, C.S.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 06/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 AVE FD ROOSEVELT SUITE 808 TORRE DE PLAZA LAS AMERICAS
SAN JUAN PR
00918-8001
US

IV. Provider business mailing address

PO BOX 140100
ARECIBO PR
00614-0100
US

V. Phone/Fax

Practice location:
  • Phone: 787-764-0078
  • Fax: 787-753-3702
Mailing address:
  • Phone: 787-764-0078
  • Fax: 787-753-3702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number3004
License Number StatePR

VIII. Authorized Official

Name: DR. JOSE RAFAEL ZARAGOZA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-764-0078