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General NPI Number Information
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NPI Number | 1013003144
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Entity Type | Organization
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Legal Business Name | INSTITUTO DE ARTRITIS DEL OESTE
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | SAN GERMAN MEDICAL PLAZA, SUITE 203-205 ROAD #2 KM 174
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City | SAN GERMAN
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State | PR
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Zip | 00683
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Country | US
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Telephone | 787-264-0818
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3445
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City | LAJAS
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State | PR
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Zip | 00667-3445
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Country | US
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Telephone | 787-264-0818
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OF CORPORATION
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Name | DR. ROBERTO ENRIQUE PANCORBO
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Credential | MD
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Telephone | 787-264-0818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 15453
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License Number State | PR
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