# BAJALU, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144813551
- **Authorized official:** DR. RAFAEL A. GAVILANES DMD (VICE-PRESIDENTE)
- **Authorized official phone:** (787) 510-0912

## Contact information

- **Practice address:** 1005 AVE GENERAL RAMEY STE 1, SAN ANTONIO, PR 00690-1109
- **Practice address phone:** (787) 510-0912
- **Mailing address:** PO BOX 784, SAN ANTONIO, PR 00690-0784
- **Mailing address phone:** (787) 510-0912

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 02/17/2021
- **Last updated:** 03/04/2021