Healthcare Provider Details

I. General information

NPI: 1578724605
Provider Name (Legal Business Name): OMAYPER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 ARZUAGA ST SUITE 605
SAN JUAN PR
00925-3321
US

IV. Provider business mailing address

112 CALLE ARZUAGA SUITE 605
SAN JUAN PR
00925-3321
US

V. Phone/Fax

Practice location:
  • Phone: 787-547-3933
  • Fax: 787-763-0200
Mailing address:
  • Phone: 787-547-3933
  • Fax: 787-763-0200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number651408
License Number StatePR

VIII. Authorized Official

Name: DR. OMAYRA PEREIRA ESTRADA
Title or Position: DOCTOR
Credential: MD
Phone: 787-547-3933