Healthcare Provider Details

I. General information

NPI: 1457886533
Provider Name (Legal Business Name): JAVIER A COUTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 CALLE SAN JORGE STE 200
SAN JUAN PR
00912-3312
US

IV. Provider business mailing address

373 CALLE SAN JORGE STE 200
SAN JUAN PR
00912-3312
US

V. Phone/Fax

Practice location:
  • Phone: 787-422-0004
  • Fax:
Mailing address:
  • Phone: 787-422-0004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number22134
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: