Healthcare Provider Details

I. General information

NPI: 1235020249
Provider Name (Legal Business Name): RAYMOND A ARCE BOSQUE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CALLE TOUS SOTO S STE 1
SAN LORENZO PR
00754-3943
US

IV. Provider business mailing address

150 CALLE TOUS SOTO S STE 1
SAN LORENZO PR
00754-3943
US

V. Phone/Fax

Practice location:
  • Phone: 787-736-2465
  • Fax: 787-736-2465
Mailing address:
  • Phone: 787-736-2465
  • Fax: 787-736-2465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number1526
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: