Healthcare Provider Details

I. General information

NPI: 1972002277
Provider Name (Legal Business Name): PRENTA PUERTO RICO EAR NOSE AND THROAT AFFILATES GRP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 02/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 CALLE SAN JORGE STE 501
SAN JUAN PR
00912-3241
US

IV. Provider business mailing address

PO BOX 362707
SAN JUAN PR
00936-2707
US

V. Phone/Fax

Practice location:
  • Phone: 787-268-2300
  • Fax: 787-268-3055
Mailing address:
  • Phone: 787-268-2300
  • Fax: 787-268-3055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLOS GONZALEZ-AQUINO
Title or Position: MEMBER
Credential: MD
Phone: 787-268-2300