Organization
SOC DRES ATILANO LEON, JOSE A MORALES, EDGAR ECHEVARRIA
Active
Other names
Soc Cirugia Oral y Maxilofacial
Organization subpart
No
Provider details
NPI number
Authorized official
MS. EMMA GISELA MONTANEZ (ADMINISTRATOR)
(787) 374-1181
Entity
Organization
Contact information
Practice address
570 CALLE NAPOLES STE 208, CONCORDIA GARDENS SHOPPING CTR, RIO PIEDRAS, PR 00924-4605
(787) 755-4347
(787) 283-7440
Mailing address
PO BOX 29736, SAN JUAN, PR 00929-0736
(787) 755-4347
(787) 283-7440
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004-0826CI
SSS PROVIDER NOMBER
PR
01
—
067099
LA CRUZ AZUL PROVIDER NOM
PR
01
—
4390
PMC PROVIDER NOMBER
PR
Enumeration date
05/12/2007
Last updated
08/22/2020
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