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General NPI Number Information
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NPI Number | 1154805034
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Entity Type | Organization
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Legal Business Name | OMEGA II LLC
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Dates
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Enumeration Date | 09/18/2018
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Last Update Date | 09/18/2018
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Provider Practice Location Address
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Address Line | 1429 AVE FERNANDEZ JUNCOS STE 3
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City | SAN JUAN
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State | PR
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Zip | 00909-2658
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Country | US
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Telephone | 787-475-0757
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Fax |
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Provider Business Mailing Address
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Address Line | 1429 AVE FERNANDEZ JUNCOS STE 3
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City | SAN JUAN
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State | PR
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Zip | 00909-2658
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Country | US
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Telephone | 787-475-0757
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, SECRETARY, TREASURER
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Name | MARIA C SOTO
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Credential | MD
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Telephone | 787-475-0757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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