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General NPI Number Information
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NPI Number | 1134752306
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Entity Type | Organization
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Legal Business Name | PLAZA PODIATRY CENTER, LLC
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Dates
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Enumeration Date | 02/17/2020
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Last Update Date | 12/09/2020
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Provider Practice Location Address
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Address Line | 525 AVE ROOSEVELT TORRE PLAZA LAS AMERICAS SUITE 612
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City | SAN JUAN
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State | PR
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Zip | 00918
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Country | US
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Telephone | 787-957-3147
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Fax |
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Provider Business Mailing Address
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Address Line | 525 AVE ROOSEVELT TORRE PLAZA LAS AMERICAS SUITE 612
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City | SAN JUAN
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State | PR
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Zip | 00918
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRADORA
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Name | MRS. DENISE L MENDOZA
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Credential |
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Telephone | 939-252-1553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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