Basic Information
| Provider Information | |||||||||
| NPI: | 1467685818 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DICEV | ||||||||
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| Mailing Information | |||||||||
| Address1: | 405 AVE ESMERALDA | ||||||||
| Address2: | SUITE 102-356 | ||||||||
| City: | GUAYNABO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009694466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874325223 | ||||||||
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| Practice Location | |||||||||
| Address1: | BARRIO HATO TEJAS CARRETERA # 862 KM. 1.9 | ||||||||
| Address2: | |||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872693140 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2009 | ||||||||
| LastUpdateDate: | 05/06/2013 | ||||||||
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| AuthorizedOfficialLastName: | ESTEBAN MALARET | ||||||||
| AuthorizedOfficialFirstName: | REBECCA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7874325223 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.