Healthcare Provider Details

I. General information

NPI: 1952075434
Provider Name (Legal Business Name): CENTRO DE ALERGIA E INMUNOLOGIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 08/06/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1728 CALLE SEGRE URB. RIO PIEDRAS HEIGHTS
SAN JUAN PR
00926
US

IV. Provider business mailing address

PO BOX 9545
CAGUAS PR
00726-9545
US

V. Phone/Fax

Practice location:
  • Phone: 939-336-7476
  • Fax: 939-336-7475
Mailing address:
  • Phone: 939-336-7476
  • Fax: 939-336-7475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. YANIRA BENITEZ ORTIZ
Title or Position: PRESIDENT
Credential: MD
Phone: 939-336-7476