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General NPI Number Information
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NPI Number | 1548651417
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Entity Type | Organization
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Legal Business Name | PONTEZUELA GROUP PSC
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Dates
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Enumeration Date | 02/12/2015
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Last Update Date | 02/12/2015
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Provider Practice Location Address
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Address Line | 10 AVE. JOSE TONY SANTANA EDIF 1 LOCAL C
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City | CAROLINA
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State | PR
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Zip | 00979
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Country | US
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Telephone | 787-757-2347
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 38095
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City | SAN JUAN
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State | PR
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Zip | 00937-1095
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Country | US
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Telephone | 787-757-2347
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Fax |
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Authorized Official
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Title or Position | PRESIDENTE
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Name | DR. CHARLES AYALA
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Credential | M.D.
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Telephone | 787-964-7184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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