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Organization
BAJALU, LLC
Active
Organization
BAJALU, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAFAEL A. GAVILANES DMD (VICE-PRESIDENTE)
(787) 510-0912
Entity
Organization
Contact information
Practice address
1005 AVE GENERAL RAMEY STE 1, SAN ANTONIO, PR 00690-1109
(787) 510-0912
Mailing address
PO BOX 784, SAN ANTONIO, PR 00690-0784
(787) 510-0912
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
02/17/2021
Last updated
03/04/2021
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