Provider Demographics
NPI:1457328312
Name:CLINICA OFTALMICA DE LA MONTANA, C.S.P.
Entity Type:Organization
Organization Name:CLINICA OFTALMICA DE LA MONTANA, C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:RAUL
Authorized Official - Last Name:SANTIAGO-PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-991-1325
Mailing Address - Street 1:56 CALLE PEDRO ROSARIO
Mailing Address - Street 2:PO BOX 455
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-3238
Mailing Address - Country:US
Mailing Address - Phone:787-991-1325
Mailing Address - Fax:787-991-2305
Practice Address - Street 1:56 CALLE PEDRO ROSARIO
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-3238
Practice Address - Country:US
Practice Address - Phone:787-991-1325
Practice Address - Fax:787-991-2305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12782302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization