Provider Demographics
NPI:1861976912
Name:WEST COAST ORAL & MAXILLOFACIAL SURGERY PSC
Entity type:Organization
Organization Name:WEST COAST ORAL & MAXILLOFACIAL SURGERY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL LLANO TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-891-2555
Mailing Address - Street 1:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00605-0022
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AGUADILLA MEDICAL BUILDING
Practice Address - Street 2:ST. PROGRESO #2 SUITE 303
Practice Address - City:AGUADILLA
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00603
Practice Address - Country:UM
Practice Address - Phone:787-891-2555
Practice Address - Fax:787-891-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1265778161OtherNPI