Provider Demographics
NPI:1922556661
Name:ECB PONCE CORP
Entity Type:Organization
Organization Name:ECB PONCE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-812-4444
Mailing Address - Street 1:83 CALLE UNION
Mailing Address - Street 2:SUITE 129
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-3686
Mailing Address - Country:US
Mailing Address - Phone:787-812-4444
Mailing Address - Fax:787-813-0843
Practice Address - Street 1:83 CALLE UNION
Practice Address - Street 2:SUITE 129
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3686
Practice Address - Country:US
Practice Address - Phone:787-812-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR276332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier