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General NPI Number Information
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NPI Number | 1851667273
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Entity Type | Organization
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Legal Business Name | OSTOLAZA-BEY CSP
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Dates
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Enumeration Date | 03/29/2012
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Last Update Date | 03/29/2012
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Provider Practice Location Address
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Address Line | 735 AVE PONCE DE LEON SUITE 714
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City | HATO REY
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State | PR
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Zip | 00917-5022
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Country | US
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Telephone | 787-430-6722
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Fax | 787-294-1454
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Provider Business Mailing Address
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Address Line | 735 AVE PONCE DE LEON SUITE 714
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City | HATO REY
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State | PR
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Zip | 00917-5022
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Country | US
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Telephone | 787-430-6722
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Fax | 787-294-1454
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JORGE OSTOLAZA
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Credential | PHYSICIAN
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Telephone | 787-614-6722
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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 | 9216
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License Number State | PR
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