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General NPI Number Information
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NPI Number | 1295269900
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Entity Type | Organization
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Legal Business Name | ENDOMED LLC
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Dates
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Enumeration Date | 04/19/2017
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Last Update Date | 11/30/2023
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Provider Practice Location Address
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Address Line | 655 CALLE EUROPA, EDIF CHINEA OFICINA 201
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City | SAN JUAN
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State | PR
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Zip | 00909-0090
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Country | US
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Telephone | 787-727-8295
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Fax | 787-727-1735
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Provider Business Mailing Address
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Address Line | PO BOX 192485
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City | SAN JUAN
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State | PR
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Zip | 00919-2485
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Country | US
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Telephone | 787-315-5170
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DALITZA M ALVAREZ VALENTIN
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Credential | M.D
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Telephone | 787-315-5170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 18108
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License Number State | PR
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