Healthcare Provider Details

I. General information

NPI: 1225289630
Provider Name (Legal Business Name): CHARLES VIERA TEM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2008
Last Update Date: 10/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 LOS ROBLES STREET URB LAS CUMBRES
SAN JUAN PR
00926
US

IV. Provider business mailing address

439 LOS ROBLES STREET URB LAS CUMBRES
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-790-4342
  • Fax:
Mailing address:
  • Phone: 787-790-4342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License NumberTC-AMB-131
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: