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General NPI Number Information
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NPI Number | 1629405287
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Entity Type | Organization
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Legal Business Name | EMBATA CORP.
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Dates
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Enumeration Date | 09/27/2013
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Last Update Date | 09/27/2013
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Provider Practice Location Address
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Address Line | 6410 AVE ISLA VERDE APT 4 L ESTE
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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 | 787-373-9664
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Fax |
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Provider Business Mailing Address
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Address Line | J 6 CALLE 2 URB. BRISAS DEL MAR
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City | LUQUILLO
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State | PR
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Zip | 00773
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Country | US
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Telephone | 787-355-1222
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MIGUEL JUAN GOYECHEA
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Credential | M.D.
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Telephone | 787373966466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 13819
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License Number State | PR
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