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General NPI Number Information
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NPI Number | 1295732147
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Entity Type | Organization
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Legal Business Name | PATRICIO J. SUMAZA, DMD, CSP
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 06/28/2012
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Provider Practice Location Address
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Address Line | 351 AVE HOSTOS SUITE 211, MEDICAL EMPORIUM
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City | MAYAGUEZ
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State | PR
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Zip | 00680-1502
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Country | US
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Telephone | 787-986-3636
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Fax | 787-805-1610
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Provider Business Mailing Address
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Address Line | 351 AVE HOSTOS SUITE 211, MEDICAL EMPORIUM
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City | MAYAGUEZ
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State | PR
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Zip | 00680-1502
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Country | US
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Telephone | 787-986-3636
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Fax | 787-805-1610
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Authorized Official
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Title or Position | PRESIDENTE
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Name | DR. PATRICIO JAVIER SUMAZA
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Credential | DMD
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Telephone | 787-986-3636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 2496
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License Number State | PR
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