# EASTERN RETINA CONSULTANTS OF PUERTO RICO, PSC

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

## Provider details

- **NPI number:** 1831505841
- **Authorized official:** GABRIEL ALBERTO BENITEZ BAJANDAS M.D. (PRESIDENT)
- **Authorized official phone:** (787) 697-1171

## Contact information

- **Practice address:** \#15 AVE. PADRE RIVERA, HUMACAO, PR 00791
- **Practice address phone:** (787) 852-6825
- **Practice address fax:** (787) 850-5005
- **Mailing address:** \#15 AVE. PADRE RIVERA, HUMACAO, PR 00791
- **Mailing address phone:** (787) 852-6825
- **Mailing address fax:** (787) 850-5005

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 339876 | PR | Yes |

## Other

- **Enumeration date:** 07/10/2014
- **Last updated:** 07/10/2014