Healthcare Provider Details

I. General information

NPI: 1023997764
Provider Name (Legal Business Name): EDWIN ANDRES ALICEA CHIRINO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 365067
SAN JUAN PR
00936-5067
US

IV. Provider business mailing address

1353 CALLE OLGA ESPERANZA URB. SAN MARTIN
SAN JUAN PR
00924
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2525
  • Fax:
Mailing address:
  • Phone: 787-672-1014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: