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General NPI Number Information
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NPI Number | 1801115605
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Entity Type | Organization
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Legal Business Name | AMANECER MUTUO, PSC
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Dates
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Enumeration Date | 05/19/2010
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Last Update Date | 05/19/2010
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Provider Practice Location Address
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Address Line | 5725 BLVD. MEDIA LUNA, SUITE # 5 GALERIAS DE ESCORIAL SHOPPING CENTER
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City | CAROLINA
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State | PR
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Zip | 00987
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Country | US
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Telephone | 787-453-0563
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1893
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City | CAROLINA
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State | PR
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Zip | 00984-1893
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Country | US
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Telephone | 787-453-0563
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSE A LOPEZ-CALERO
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Credential | DMD
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Telephone | 787-453-0563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 16005
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 2751
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License Number State | PR
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