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General NPI Number Information
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NPI Number | 1972204055
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Entity Type | Organization
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Legal Business Name | CLINICA INTEGRAL DE OTORRINOLARINGOLOGIA CRL
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Dates
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Enumeration Date | 03/15/2023
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Last Update Date | 03/15/2023
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Provider Practice Location Address
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Address Line | 1452 AVENIDA ASHFORD EDIFICIO ADALIGIA SUITE 1
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City | SAN JUAN
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State | PR
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Zip | 00907-1556
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Country | US
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Telephone | 787-653-9919
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 362278
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City | SAN JUAN
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State | PR
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Zip | 00936-2278
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Country | US
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Telephone | 787-653-9919
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GABRIEL HERNANDEZ
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Credential | MD
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Telephone | 787-653-9919
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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 |
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License Number State |
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