Healthcare Provider Details

I. General information

NPI: 1518035526
Provider Name (Legal Business Name): BORINQUEN SURGICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 AVE PONCE DE LEON NATIONAL PLAZA SUITE 318
SAN JUAN PR
00917-3418
US

IV. Provider business mailing address

PO BOX 19626
SAN JUAN PR
00910-1626
US

V. Phone/Fax

Practice location:
  • Phone: 787-281-3838
  • Fax: 787-281-0124
Mailing address:
  • Phone: 787-281-3838
  • Fax: 787-281-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StatePR

VIII. Authorized Official

Name: DR. REYNOLD LOPEZ ENRIQUEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-281-3838