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General NPI Number Information
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NPI Number | 1669609210
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Entity Type | Organization
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Legal Business Name | RETINA ASSOCIATES CSP
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Dates
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Enumeration Date | 06/22/2009
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 101 AVE SAN PATRICIO STE 990 MARAMAR PLAZA
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City | GUAYNABO
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State | PR
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Zip | 00968-2646
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Country | US
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Telephone | 787-625-7766
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Fax | 787-625-7768
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Provider Business Mailing Address
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Address Line | 101 AVE SAN PATRICIO STE 990 MARAMAR PLAZA
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City | GUAYNABO
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State | PR
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Zip | 00968-2646
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Country | US
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Telephone | 787-625-7766
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Fax | 787-625-7768
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. WANDSY M VELEZ
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Credential | M.D.
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Telephone | 787-625-7766
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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 | 12518
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License Number State | PR
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