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General NPI Number Information
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NPI Number | 1891194478
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Entity Type | Organization
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Legal Business Name | PEDRO J RULLAN MARIN MEDICAL SERVICES, CSP
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Dates
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Enumeration Date | 08/19/2014
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Last Update Date | 08/19/2014
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Provider Practice Location Address
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Address Line | 735 AVE PONCE DE LEON TORRE AUXILIO MUTUO # 512
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City | SAN JUAN
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State | PR
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Zip | 00917-5022
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Country | US
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Telephone | 787-751-1910
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Fax |
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Provider Business Mailing Address
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Address Line | 735 AVE PONCE DE LEON TORRE AUXILIO MUTUO # 512
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City | SAN JUAN
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State | PR
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Zip | 00917-5022
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Country | US
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Telephone | 787-751-1910
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PEDRO J RULLAN MARIN
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Credential | MD, FACS
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Telephone | 787-751-1910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YP0228X
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Taxonomy Name | Pediatric Otolaryngology Physician
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License Number | 8708
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | 8708
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 8708
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License Number State | PR
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