Provider Demographics
NPI:1366868390
Name:DR ARMANDO A. DOVAL ORTES CSP
Entity Type:Organization
Organization Name:DR ARMANDO A. DOVAL ORTES CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:DOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-922-1906
Mailing Address - Street 1:PMB 159
Mailing Address - Street 2:AVENIDA MUNOZ RIVERA 1575
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717
Mailing Address - Country:US
Mailing Address - Phone:787-922-1906
Mailing Address - Fax:
Practice Address - Street 1:# 12 CALLE SOL
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-892-1333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16613174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0029064Medicare PIN