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General NPI Number Information
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NPI Number | 1821542234
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Entity Type | Organization
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Legal Business Name | PRIME OTOLARYNGOLOGY SERVICES, PSC
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Dates
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Enumeration Date | 08/15/2016
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Last Update Date | 08/15/2016
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Provider Practice Location Address
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Address Line | 1510 AVE F.D. ROOSEVELT MEZZANINE SUITE B
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City | GUAYNABO
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State | PR
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Zip | 00968-2602
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Country | US
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Telephone | 787-706-4334
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Fax | 787-749-0993
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Provider Business Mailing Address
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Address Line | PO BOX 1036
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City | GUAYNABO
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State | PR
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Zip | 00970-1036
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Country | US
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Telephone | 787-706-4334
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Fax | 787-749-0993
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LISETTE YVONNE PEREZ
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Credential | M.D.
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Telephone | 787-706-4334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 11652
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License Number State | PR
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