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General NPI Number Information
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NPI Number | 1255668828
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Entity Type | Organization
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Legal Business Name | OPTIMUS AETAS
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Dates
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Enumeration Date | 11/03/2009
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Last Update Date | 11/03/2009
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Provider Practice Location Address
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Address Line | 550 CALLE SERGIO CUEVAS 4TO PISO
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City | SAN JUAN
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State | PR
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Zip | 00918-2683
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Country | US
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Telephone | 787-474-7629
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Fax |
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Provider Business Mailing Address
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Address Line | 429 CALLE SAN GENARO SAGRADO CORAZON
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City | SAN JUAN
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State | PR
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Zip | 00926-4221
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Country | US
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Telephone | 787-319-9226
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RUTH A SANTOS
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Credential | M.D.
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Telephone | 787-474-7629
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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