Provider Demographics
NPI:1962670752
Name:COUTIN, ORESTES
Entity Type:Individual
Prefix:
First Name:ORESTES
Middle Name:
Last Name:COUTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. LAS CUMBRES
Mailing Address - Street 2:497 AVE. E. POL PMB 167
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5636
Mailing Address - Country:US
Mailing Address - Phone:787-306-6930
Mailing Address - Fax:
Practice Address - Street 1:AVE. TNTE NELSON MARTINEZ
Practice Address - Street 2:SUITE 202
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-306-6930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2962174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist