Provider Demographics
NPI:1194251512
Name:ENDOHEALTH LLC
Entity type:Organization
Organization Name:ENDOHEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:VIVIANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ORTIZ-SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-974-7868
Mailing Address - Street 1:1575 AVE MUNOZ RIVERA
Mailing Address - Street 2:PMB 121
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-0211
Mailing Address - Country:US
Mailing Address - Phone:787-974-7868
Mailing Address - Fax:
Practice Address - Street 1:4 BS AVE LAS AMERICAS
Practice Address - Street 2:URB BAIROA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-974-7868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18803261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty