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General NPI Number Information
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NPI Number | 1033642988
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Entity Type | Organization
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Legal Business Name | EGS RETINA CRL
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Dates
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Enumeration Date | 04/07/2017
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Last Update Date | 04/07/2017
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Provider Practice Location Address
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Address Line | 152 DORADO BCH E
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City | DORADO
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State | PR
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Zip | 00646-2203
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Country | US
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Telephone | 787-934-4303
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Fax |
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Provider Business Mailing Address
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Address Line | 152 DORADO BCH E
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City | DORADO
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State | PR
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Zip | 00646-2203
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Country | US
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Telephone | 787-934-4303
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EDUARDO GONZALEZ
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Credential | MD
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Telephone | 787-934-4303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 19558
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License Number State | PR
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