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General NPI Number Information
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NPI Number | 1376949933
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Entity Type | Organization
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Legal Business Name | REDNOSTIC
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Dates
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Enumeration Date | 11/10/2014
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Last Update Date | 11/10/2014
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Provider Practice Location Address
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Address Line | 11 AVE SIMON MADERA
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City | SAN JUAN
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State | PR
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Zip | 00924-2231
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Country | US
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Telephone | 787-420-4054
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Fax |
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Provider Business Mailing Address
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Address Line | 781 VIA DE LA HERMITA HACIENDA SAN JOSE
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City | CAGUAS
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State | PR
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Zip | 00727-3101
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Country | US
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Telephone | 787-420-4054
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. REYNALDO PEZZOTTI SMITH
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Credential | MD
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Telephone | 787-420-4054
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 17615
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License Number State | PR
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