Healthcare Provider Details

I. General information

NPI: 1992181184
Provider Name (Legal Business Name): TC SURGICAL PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDA PONCE DE LEON PARADA 37 1/2
SAN JUAN PR
00919-1227
US

IV. Provider business mailing address

P.O. BOX 10189
SAN JUAN PR
00908-0189
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2000
  • Fax: 787-771-7952
Mailing address:
  • Phone: 787-758-2000
  • Fax: 787-771-7952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number18768
License Number StatePR

VIII. Authorized Official

Name: DR. VANGIE A TEXIDOR
Title or Position: PRESIDENT, SECRETARY, TREASURER
Credential: M.D.
Phone: 787-342-1294