=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407351489
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANTONIO FRANCISCO ARRIETA ALICEA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2018
-----------------------------------------------------
Last Update Date | 04/28/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9615 AVE LOS ROMEROS STE 301
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00926-7068
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-244-5043
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9615 AVE LOS ROMEROS SUITE 301
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00926-7068
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-244-5043
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 22245
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------