Provider Demographics
NPI:1639748767
Name:ASE MD LLC
Entity Type:Organization
Organization Name:ASE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:SOFIA
Authorized Official - Last Name:EMMANUELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-238-2959
Mailing Address - Street 1:902 AVE PONCE DE LEON APT 705
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-3351
Mailing Address - Country:US
Mailing Address - Phone:787-238-2959
Mailing Address - Fax:
Practice Address - Street 1:EXT VILLAMAR
Practice Address - Street 2:1025 MARGINAL VILLAMAR
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-0097
Practice Address - Country:US
Practice Address - Phone:787-726-3901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care