Provider Demographics
NPI:1104604768
Name:ECB HUMACAO
Entity type:Organization
Organization Name:ECB HUMACAO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-801-5896
Mailing Address - Street 1:PLAZA FAJARDO
Mailing Address - Street 2:CARR 3 KM 43.3 SUITE 125
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:787-801-5896
Mailing Address - Fax:
Practice Address - Street 1:PLAZA FAJARDO
Practice Address - Street 2:CARR 3 KM 43.3 SUITE 125
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-801-5896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ECB HUMACAO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-15
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty