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General NPI Number Information
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NPI Number | 1043636384
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Entity Type | Organization
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Legal Business Name | DENTIST@LATIENDA, LLC
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Dates
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Enumeration Date | 03/11/2014
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Last Update Date | 03/11/2014
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Provider Practice Location Address
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Address Line | 2002 CALLE LAS VIOLTS APT 302 CITY VIEW TOWER
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City | SAN JUAN
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State | PR
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Zip | 00915-3544
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Country | US
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Telephone | 787-600-0630
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Fax |
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Provider Business Mailing Address
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Address Line | 2002 CALLE LAS VIOLETAS APT 302 CITY VIEW TOWER
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City | SAN JUAN
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State | PR
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Zip | 00915-3544
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Country | US
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Telephone | 787-600-0630
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Fax |
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Authorized Official
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Title or Position | REPRESENTANTE
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Name | MR. FELIX A ALVAREZ
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Credential |
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Telephone | 787-600-0630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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