Provider Demographics
NPI:1043636384
Name:DENTIST@LATIENDA, LLC
Entity type:Organization
Organization Name:DENTIST@LATIENDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REPRESENTANTE
Authorized Official - Prefix:MR
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-600-0630
Mailing Address - Street 1:2002 CALLE LAS VIOLETAS APT 302
Mailing Address - Street 2:CITY VIEW TOWER
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00915-3544
Mailing Address - Country:US
Mailing Address - Phone:787-600-0630
Mailing Address - Fax:
Practice Address - Street 1:2002 CALLE LAS VIOLTS APT 302
Practice Address - Street 2:CITY VIEW TOWER
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00915-3544
Practice Address - Country:US
Practice Address - Phone:787-600-0630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental