Provider Demographics
NPI:1922368448
Name:DR. HOWARD J. WETTERER DUCLERC,CSP
Entity Type:Organization
Organization Name:DR. HOWARD J. WETTERER DUCLERC,CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:JOHM
Authorized Official - Last Name:WETTERER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-342-9228
Mailing Address - Street 1:426 CALLE SAN GENARO
Mailing Address - Street 2:SAGRADO CORAZON
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4220
Mailing Address - Country:US
Mailing Address - Phone:787-342-9228
Mailing Address - Fax:787-801-3158
Practice Address - Street 1:313 AVE GENERAL VALERO
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-4855
Practice Address - Country:US
Practice Address - Phone:787-801-3158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14536261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care