=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295431070
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GLOBAL VYTRONICS PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2023
-----------------------------------------------------
Last Update Date | 02/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 502 CALLE RIAZA
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00923-2120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-963-0977
-----------------------------------------------------
Fax | 787-963-0977
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 502 CALLE RIAZA
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00923-2120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-963-0977
-----------------------------------------------------
Fax | 787-963-0977
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | WANDA E GOMEZ FRIAS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 787-635-2840
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------