Organization · NPI-2

Centro Otologico De Puerto Rico Csp

Otolaryngology, Otology & Neurotology · Mayaguez, PR

NPI number1619958634
StatusActive
Last updated in NPPESJul 12, 2011

Details

NPI
1619958634
Entity type
Organization (NPI-2)
Legal business name
Centro Otologico De Puerto Rico Csp
Organization subpart
No
Enumeration date
Nov 8, 2005
Last updated
Jul 12, 2011

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207YX0901X Otolaryngology, Otology & Neurotology11064PRYes
231H00000X Audiologist11064PR

Practice location

55 Calle De Diego E
Suite 105
Mayaguez, PR 00680-5078

Phone 787-833-2155 · Fax 787-833-2680

Mailing address

Po Box 6428
Mayaguez, PR 00681-6428

Phone 787-833-2155 · Fax 787-833-2680

Authorized official

Miguel A Lasalle Lopez
Owner
7878332155

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