| West Side Llc | |
|
Carr 459 Km 1.8 Int Aguadilla PR 00603 | |
| (787) 718-2284 | |
| Not Available |
| Full Name | West Side Llc |
|---|---|
| Speciality | Dentist |
| Location | Carr 459 Km 1.8 Int, Aguadilla, Puerto Rico |
| Authorized Official Name and Position | Abimelec Portalatin Perez (OWNER) |
| Authorized Official Contact | 7877182284 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| West Side Llc Po Box 310 San Antonio PR 00690-0310 Ph: (787) 718-2284 | West Side Llc Carr 459 Km 1.8 Int Aguadilla PR 00603 Ph: (787) 718-2284 |
| NPI Number | 1184363459 |
|---|---|
| Provider Enumeration Date | 06/03/2022 |
| Last Update Date | 09/08/2022 |
| Medicare PECOS PAC ID | 1153798962 |
|---|---|
| Medicare Enrollment ID | O20221108002496 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184363459 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| Provider Name | Abimelec Portalatin Perez |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1689313587 PECOS PAC ID: 0345617148 Enrollment ID: I20221108002441 |
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