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General NPI Number Information
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NPI Number | 1053551929
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Entity Type | Organization
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Legal Business Name | CLINICA DE OJOS DE GUAYAMA INC
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Dates
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Enumeration Date | 03/04/2009
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Last Update Date | 03/04/2009
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Provider Practice Location Address
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Address Line | COMMERCE PLAZA URB. COSTA AZUL SUITE 101 G CALLE 13 ESQ CALLE 11
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City | GUAYAMA
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State | PR
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Zip | 00784
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Country | US
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Telephone | 787-864-7902
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Fax | 787-864-7902
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Provider Business Mailing Address
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Address Line | COMMERCE PLAZA URB. COSTA AZUL SUITE 101 G CALLE 13 ESQ CALLE 11
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City | GUAYAMA
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State | PR
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Zip | 00784
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Country | US
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Telephone | 787-864-7902
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Fax | 787-864-7902
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Authorized Official
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Title or Position | OPTOMETRIEST/PRESIDENT
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Name | DR. ERICBERTO COTTO
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Credential | OD
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Telephone | 787-864-7902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1800X
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Taxonomy Name | Corporate Health Clinic/Center
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License Number | 471
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License Number State | PR
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