Provider Demographics
NPI:1104002732
Name:ANTILLES FOOT CLINIC
Entity Type:Organization
Organization Name:ANTILLES FOOT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ CORDOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-783-6650
Mailing Address - Street 1:PO BOX 366987
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936
Mailing Address - Country:US
Mailing Address - Phone:787-783-6650
Mailing Address - Fax:787-783-5578
Practice Address - Street 1:1229 AVE JESUS T PINERO
Practice Address - Street 2:
Practice Address - City:PUERTO NUEVO
Practice Address - State:PR
Practice Address - Zip Code:00920-5502
Practice Address - Country:US
Practice Address - Phone:787-783-6650
Practice Address - Fax:787-783-5578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0049213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty