Organization
CENTRO OTOLOGICO DE PUERTO RICO CSP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIGUEL A LASALLE LOPEZ MD (OWNER)
(787) 833-2155
Entity
Organization
Contact information
Practice address
55 CALLE DE DIEGO E, SUITE 105, MAYAGUEZ, PR 00680-5078
(787) 833-2155
(787) 833-2680
Mailing address
PO BOX 6428, MAYAGUEZ, PR 00681-6428
(787) 833-2155
(787) 833-2680
Taxonomy
Speciality
Code
Description
License number
State
207YX0901X
Otology & Neurotology Physician
Primary
11064
PR
231H00000X
Audiologist
11064
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20192
TRIPLES
—
Enumeration date
11/08/2005
Last updated
07/12/2011
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