Organization
AESTHETIC CENTER OF PUERTO RCO CSP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LUIS IVAN MORELL (PRECIDENT)
(787) 850-8217
Entity
Organization
Contact information
Practice address
355 AVE FONT MARTELO, HOSPITAL RYDER OFICINA 402, HUMACAO, PR 00791-3249
(787) 850-8217
Mailing address
100 GRAND BLVD PASEO, SUITE 112 MSC 486, SAN JUAN, PR 00926
(787) 850-8217
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20484MO
—
PR
Enumeration date
12/28/2010
Last updated
12/28/2010
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