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General NPI Number Information
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NPI Number | 1174657340
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Entity Type | Organization
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Legal Business Name | BANUCCI INSTITUTE
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 06/01/2015
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Provider Practice Location Address
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Address Line | 302 AVE. DOMENECH
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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 | 787-759-7490
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Fax | 787-759-7150
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Provider Business Mailing Address
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Address Line | 551 CALLE TRIGO
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City | SAN JUAN
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State | PR
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Zip | 00907-2511
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Country | US
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Telephone | 787-759-7490
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Fax | 787-759-7150
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Authorized Official
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Title or Position | OWNER
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Name | DR. ISABEL M. BANUCHI
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Credential | M.D.
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Telephone | 787-759-7490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State | PR
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