Healthcare Provider Details

I. General information

NPI: 1376949933
Provider Name (Legal Business Name): REDNOSTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 AVE SIMON MADERA
SAN JUAN PR
00924-2231
US

IV. Provider business mailing address

781 VIA DE LA HERMITA HACIENDA SAN JOSE
CAGUAS PR
00727-3101
US

V. Phone/Fax

Practice location:
  • Phone: 787-420-4054
  • Fax:
Mailing address:
  • Phone: 787-420-4054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number17615
License Number StatePR

VIII. Authorized Official

Name: DR. REYNALDO PEZZOTTI SMITH
Title or Position: PRESIDENT
Credential: MD
Phone: 787-420-4054