Provider Demographics
NPI:1659803815
Name:CARIBBEAN FACIAL PLASTIC SURGERY CENTER, PSC
Entity Type:Organization
Organization Name:CARIBBEAN FACIAL PLASTIC SURGERY CENTER, PSC
Other - Org Name:CARIBBEANFPS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-249-2170
Mailing Address - Street 1:PO BOX 16423
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00908-6423
Mailing Address - Country:US
Mailing Address - Phone:787-717-8911
Mailing Address - Fax:
Practice Address - Street 1:66 CALLE SANTA CRUZ
Practice Address - Street 2:INSTITUTO SAN PABLO SUITE 407
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-717-8911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19036207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty