Healthcare Provider Details

I. General information

NPI: 1174724967
Provider Name (Legal Business Name): MAGDA V. RUBERO APONTE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 CALLE MUNOZ RIVERA
TRUJILLO ALTO PR
00976-5932
US

IV. Provider business mailing address

RF-5 PIAZA 7 RIO CRISTAL ,ENCANTADA
TRUJILLO ALTO PR
00976
US

V. Phone/Fax

Practice location:
  • Phone: 787-755-2585
  • Fax: 787-748-4176
Mailing address:
  • Phone: 787-755-2585
  • Fax: 787-748-4176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number461
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: