Provider Demographics
NPI:1346665023
Name:PLASTIC SURGERY & LASER CENTER
Entity Type:Organization
Organization Name:PLASTIC SURGERY & LASER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:J
Authorized Official - Last Name:PEREZ RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-961-4023
Mailing Address - Street 1:PO BOX 7377
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-7377
Mailing Address - Country:US
Mailing Address - Phone:787-961-4023
Mailing Address - Fax:
Practice Address - Street 1:A18 AVE DEGETAU
Practice Address - Street 2:URB BONNEVILLE TERRACE
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-5836
Practice Address - Country:US
Practice Address - Phone:787-961-4023
Practice Address - Fax:787-961-4026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7149261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7149OtherSTATE LICENSE
PR7149OtherSTATE LICENSE