Healthcare Provider Details

I. General information

NPI: 1649501800
Provider Name (Legal Business Name): ERNESTO MUNOZ VILCHES C.S.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2010
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WASHIGNTON #29 ASHFORD MEDICAL CENTER SUITE 208 -B
SAN JUAN PR
00907
US

IV. Provider business mailing address

PMB 270 PO BOX 4956
CAGUAS PR
00726-4956
US

V. Phone/Fax

Practice location:
  • Phone: 787-721-4836
  • Fax: 787-721-8448
Mailing address:
  • Phone: 787-630-4060
  • Fax: 787-721-8448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number11412
License Number StatePR

VIII. Authorized Official

Name: DR. ERNESTO JOAQUIN MUNOZ VILCHES
Title or Position: PRESIDENT
Credential: MD
Phone: 787-630-4060