Healthcare Provider Details

I. General information

NPI: 1760755060
Provider Name (Legal Business Name): PAVIA RESEARCH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 02/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 CALLE PAVIA OFICINA 214
SAN JUAN PR
00909-2239
US

IV. Provider business mailing address

PO BOX 19405
SAN JUAN PR
00910-1405
US

V. Phone/Fax

Practice location:
  • Phone: 787-726-7008
  • Fax: 787-727-5888
Mailing address:
  • Phone: 787-726-7008
  • Fax: 787-727-5888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LUIS QUESADA
Title or Position: PRESIDENTE
Credential: MD
Phone: 787-726-7008