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General NPI Number Information
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NPI Number | 1932265246
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Entity Type | Individual
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Provider Name | WALDEMAR PAOLI BREBAN MD
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Gender | Male
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 09/29/2016
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Provider Practice Location Address
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Address Line | BO PASO SECO RD 153 SECTOR EL OJO 456
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City | SANTA ISABEL
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State | PR
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Zip | 00757
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Country | US
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Telephone | 787-845-5300
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Fax |
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Provider Business Mailing Address
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Address Line | A 12 GUANINA VILLA BORINQUEN
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-607-0353
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 15582
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 15582
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License Number State | PR
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