Healthcare Provider Details

I. General information

NPI: 1336894286
Provider Name (Legal Business Name): OPTIMA GYN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2022
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 CALLE PAVIA STE 203
SAN JUAN PR
00909-2242
US

IV. Provider business mailing address

120 AVE CARLOS CHARDON APT 129
SAN JUAN PR
00918-1721
US

V. Phone/Fax

Practice location:
  • Phone: 787-433-2526
  • Fax:
Mailing address:
  • Phone: 787-307-0741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SOAN GILY CRUZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-307-0741