Provider Demographics
NPI:1558631630
Name:GRUPO DENTAL DR.GUALBERTO RABELL
Entity type:Organization
Organization Name:GRUPO DENTAL DR.GUALBERTO RABELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE SUB DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGA DE JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA HCM
Authorized Official - Phone:787-480-3841
Mailing Address - Street 1:CALLE CERRA FINAL #900 PDA.15
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920
Mailing Address - Country:US
Mailing Address - Phone:787-480-3841
Mailing Address - Fax:787-977-0544
Practice Address - Street 1:CALLE CERRA FINAL #900 PDA.15
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920
Practice Address - Country:US
Practice Address - Phone:787-480-3841
Practice Address - Fax:787-977-0544
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CDT DR.GUALBERTO RABELL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR101261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR400015Medicare PIN