Provider Demographics
NPI:1134593577
Name:JOSE RAUL MONTES EYES & FACIAL REJUVENATION, LLC
Entity type:Organization
Organization Name:JOSE RAUL MONTES EYES & FACIAL REJUVENATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE-(OWNER)
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:RAUL
Authorized Official - Last Name:MONTES PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-777-0003
Mailing Address - Street 1:735 AVE. PONCE DE LEON SUITE 813
Mailing Address - Street 2:TORRE MEDICA AUXILIO MUTUO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917
Mailing Address - Country:US
Mailing Address - Phone:787-777-0003
Mailing Address - Fax:787-777-0004
Practice Address - Street 1:735 AVE. PONCE DE LEON SUITE 813
Practice Address - Street 2:TORRE MEDICA AUXILIO MUTUO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-777-0003
Practice Address - Fax:787-777-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG40348Medicare UPIN