Healthcare Provider Details

I. General information

NPI: 1386691764
Provider Name (Legal Business Name): ELSIE M WISCOVICH-TERUEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CONDOMINIO PICO CENTER LOCAL 101 CONDADO 120
SAN JUAN PR
00907
US

IV. Provider business mailing address

VILLA DE TORRIMAR 410 REINA ISABEL
GUAYNABO PR
00969-3342
US

V. Phone/Fax

Practice location:
  • Phone: 787-977-3897
  • Fax: 787-722-5305
Mailing address:
  • Phone: 787-731-9391
  • Fax: 787-287-0974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number6665
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: