=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508073297
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARIBBEAN RETINA CONSULTANTS PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2007
-----------------------------------------------------
Last Update Date | 06/06/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | HIMA PLAZA 1, SUITE 400 AVE. DEGETAU
-----------------------------------------------------
City | CAGUAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-961-4636
-----------------------------------------------------
Fax | 787-653-3724
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PMB 644 1353, RD 19
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00966
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-961-4636
-----------------------------------------------------
Fax | 787-653-3724
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MISS CRISTINA PENA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-961-4636
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------