Healthcare Provider Details

I. General information

NPI: 1205832144
Provider Name (Legal Business Name): GUILLERMO ACARON SOUFFRONT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 10/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 AVE PONCE DE LEON
SAN JUAN PR
00918-4503
US

IV. Provider business mailing address

PO BOX 362025
SAN JUAN PR
00936-2025
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-7500
  • Fax: 787-758-0975
Mailing address:
  • Phone: 787-758-1243
  • Fax: 787-758-0975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2908
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: