Provider Demographics
NPI:1851667273
Name:OSTOLAZA-BEY CSP
Entity Type:Organization
Organization Name:OSTOLAZA-BEY CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTOLAZA
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICIAN
Authorized Official - Phone:787-614-6722
Mailing Address - Street 1:735 AVE PONCE DE LEON
Mailing Address - Street 2:SUITE 714
Mailing Address - City:HATO REY
Mailing Address - State:PR
Mailing Address - Zip Code:00917-5022
Mailing Address - Country:US
Mailing Address - Phone:787-430-6722
Mailing Address - Fax:787-294-1454
Practice Address - Street 1:735 AVE PONCE DE LEON
Practice Address - Street 2:SUITE 714
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00917-5022
Practice Address - Country:US
Practice Address - Phone:787-430-6722
Practice Address - Fax:787-294-1454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9216174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty