Provider Demographics
NPI:1306044748
Name:CLINICA DE CIRUGIA ORAL Y MAXILOFACIAL DE CAPARRA CORP
Entity Type:Organization
Organization Name:CLINICA DE CIRUGIA ORAL Y MAXILOFACIAL DE CAPARRA CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:JIMENEZ-BOSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-210-0555
Mailing Address - Street 1:33 CALLE RESOLUCION
Mailing Address - Street 2:SUITE 800
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-2706
Mailing Address - Country:US
Mailing Address - Phone:787-622-0552
Mailing Address - Fax:787-622-0555
Practice Address - Street 1:33 CALLE RESOLUCION
Practice Address - Street 2:SUITE 800
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-2706
Practice Address - Country:US
Practice Address - Phone:787-622-0552
Practice Address - Fax:787-622-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2660261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery