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General NPI Number Information
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NPI Number | 1194319046
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Entity Type | Individual
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Provider Name | MARIELENA LAYUNO MATOS
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Gender | Female
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Dates
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Enumeration Date | 02/22/2021
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Last Update Date | 01/31/2024
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Provider Practice Location Address
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Address Line | CARR 5 KM 0.25 BO. ACHIOTE SECTOR TANITA MORALES DESVI
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City | NARANJITO
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State | PR
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Zip | 00719
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Country | US
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Telephone | 787-869-0401
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Fax |
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Provider Business Mailing Address
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Address Line | 69 CALLE SANTIAGO IGLESIAS APT 7B
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City | SAN JUAN
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State | PR
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Zip | 00907-1810
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Country | US
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Telephone | 787-644-6294
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 3483
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License Number State | PR
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