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General NPI Number Information
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NPI Number | 1659765899
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Entity Type | Organization
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Legal Business Name | OPTIMUM OB/GYN LLC
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Dates
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Enumeration Date | 03/25/2015
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Last Update Date | 03/25/2015
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Provider Practice Location Address
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Address Line | 268 AVE PONCE DE LEON HATO REY CENTER STE. 1000
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City | SAN JUAN
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State | PR
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Zip | 00918-2002
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Country | US
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Telephone | 787-266-7261
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Fax | 787-266-7263
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Provider Business Mailing Address
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Address Line | 268 AVE PONCE DE LEON HATO REY CENTER STE. 1000
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City | SAN JUAN
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State | PR
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Zip | 00918-2002
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Country | US
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Telephone | 787-266-7261
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Fax | 787-266-7263
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LUIS JAVIER CASIANO
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Credential | MD
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Telephone | 787-640-9530
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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 | 17111
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 18058
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License Number State | PR
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