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General NPI Number Information
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NPI Number | 1104179076
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Entity Type | Organization
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Legal Business Name | PUERTO RICO ENDOVASCULAR & VASCULAR SOLUTION, P.S.C
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Dates
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Enumeration Date | 10/17/2012
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Last Update Date | 10/17/2012
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Provider Practice Location Address
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Address Line | 161 CALLE SAN JORGE SUITE 402
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City | SAN JUAN
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State | PR
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Zip | 00911-2176
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Country | US
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Telephone | 787-723-4525
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Fax | 787-721-2574
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Provider Business Mailing Address
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Address Line | 161 CALLE SAN JORGE SUITE 402
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City | SAN JUAN
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State | PR
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Zip | 00911-2176
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Country | US
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Telephone | 787-723-4525
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Fax | 787-721-2574
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Authorized Official
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Title or Position | ENDOVASCULAR AND VASCULAR SURGEON
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Name | DR. JOSE DOMINGO PAGAN
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Credential |
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Telephone | 787-723-4525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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