Provider Demographics
NPI:1811328768
Name:LATONI PLASTICAND RECONSTRUCTIVE SURGERY PSC
Entity type:Organization
Organization Name:LATONI PLASTICAND RECONSTRUCTIVE SURGERY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:D
Authorized Official - Last Name:LATONI MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-831-1000
Mailing Address - Street 1:PO BOX 1856
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1856
Mailing Address - Country:US
Mailing Address - Phone:787-831-1000
Mailing Address - Fax:787-831-1000
Practice Address - Street 1:27 CALLE NELSON PEREA
Practice Address - Street 2:EDF DOCTORS CENTER SUITE 105
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4949
Practice Address - Country:US
Practice Address - Phone:787-831-1000
Practice Address - Fax:787-831-1000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11812261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR11812OtherMD LICENSE