Provider Demographics
NPI:1770731259
Name:SONRISAS HERMOSAS, CSP
Entity type:Organization
Organization Name:SONRISAS HERMOSAS, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-756-6125
Mailing Address - Street 1:PO BOX 1527
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-1527
Mailing Address - Country:US
Mailing Address - Phone:787-756-6125
Mailing Address - Fax:787-756-6125
Practice Address - Street 1:CALLE MARGINAL
Practice Address - Street 2:ROAD 1 KM. 16.1
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-2536
Practice Address - Country:US
Practice Address - Phone:787-756-6125
Practice Address - Fax:787-756-6125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1865302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization