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General NPI Number Information
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NPI Number | 1982908240
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Entity Type | Organization
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Legal Business Name | TAHIMY ORTIZ NIEVES DBA SPECIAL BREAST BOUTIQUE
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Dates
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Enumeration Date | 12/30/2010
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Last Update Date | 11/09/2011
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Provider Practice Location Address
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Address Line | AGUAS BUENAS ST. #19 URB. BONNEVILLE HEIGHTS
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City | CAGUAS
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State | PR
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Zip | 00727-4939
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Country | US
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Telephone | 787-743-9977
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Fax | 787-744-8733
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Provider Business Mailing Address
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Address Line | AGUAS BUENAS ST. #19 URB. BONNEVILLE HEIGHTS
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City | CAGUAS
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State | PR
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Zip | 00727-4939
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Country | US
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Telephone | 787-743-9977
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Fax | 787-744-8733
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Authorized Official
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Title or Position | OWNER
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Name | TAHIMY ORTIZ
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Credential |
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Telephone | 787-743-9977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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