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General NPI Number Information
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NPI Number | 1962053439
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Entity Type | Organization
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Legal Business Name | GUAYAMA ORTHODONTICS LLC
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Dates
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Enumeration Date | 09/25/2019
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Last Update Date | 10/21/2019
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Provider Practice Location Address
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Address Line | GALERIAS PLAZA GUAYAMA SUITE #8 LOS VETERANOS AVENUE
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City | GUAYAMA
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State | PR
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Zip | 00784
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Country | US
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Telephone | 787-864-8649
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Fax |
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Provider Business Mailing Address
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Address Line | GALERIAS PLAZA GUAYAMA SUITE 8 AVENIDA LOS VETERANOS
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City | GUAYAMA
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State | PR
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Zip | 00784
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Country | US
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Telephone | 787-864-8649
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHANNA RIVERA VEGA
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Credential | DMD
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Telephone | 787-864-8649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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