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General NPI Number Information
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NPI Number | 1306035928
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Entity Type | Individual
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Provider Name | MICHAEL BERETTA
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Gender | Male
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Dates
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Enumeration Date | 10/19/2007
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Last Update Date | 10/21/2009
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Provider Practice Location Address
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Address Line | EXTENSION SAN AGUSTIN # B-11 CALLE 10
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City | SAN JUAN
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State | PR
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Zip | 00926-1900
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Country | US
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Telephone | 787-646-0840
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Fax | 787-764-7796
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Provider Business Mailing Address
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Address Line | EXTENSION SAN AGUSTIN # B-11 CALLE 10
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City | SAN JUAN
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State | PR
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Zip | 00926-1900
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Country | US
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Telephone | 787-478-2050
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Fax | 787-764-7796
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | TC AMB 482
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License Number State | PR
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