Healthcare Provider Details

I. General information

NPI: 1760742423
Provider Name (Legal Business Name): GLORIA V BERLINER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 05/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CALLE LA PUNTILLA
SAN JUAN PUERTO RICO
00901
UM

IV. Provider business mailing address

500 CARR 177 APT B3
BAYAMON PUERTO RICO
00959
UM

V. Phone/Fax

Practice location:
  • Phone: 787-729-4344
  • Fax:
Mailing address:
  • Phone: 787-729-4344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number8869
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: