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General NPI Number Information
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NPI Number | 1295282499
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL ENDOCRINOLOGY INSTITUTE P.S.C
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Dates
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Enumeration Date | 09/06/2016
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Last Update Date | 09/06/2016
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Provider Practice Location Address
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Address Line | 120 CALLE CARAZO
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City | GUAYNABO
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State | PR
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Zip | 00970
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Country | US
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Telephone | 787-400-0333
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2447
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City | GUAYNABO
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State | PR
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Zip | 00970-2447
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Country | US
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Telephone | 787-400-0333
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAOLA M MANSILLA LETELIER
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Credential |
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Telephone | 787-233-9108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 18179
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License Number State | PR
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