Healthcare Provider Details

I. General information

NPI: 1467234617
Provider Name (Legal Business Name): SOFIA VICTORIA OQUENDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2023
Last Update Date: 10/20/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PROFESSIONAL OFFICES PARK IV 997 SAN ROBERTO STREET
SAN JUAN PR
00926
US

IV. Provider business mailing address

403 CALLE SEVILLA
COTO LAUREL PR
00780-2631
US

V. Phone/Fax

Practice location:
  • Phone: 787-773-6508
  • Fax: 787-773-6544
Mailing address:
  • Phone: 787-934-5003
  • 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: