1356640486 NPI number — MINIMALLY INVASIVE UROLOGY CENTER, PSC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356640486 NPI number — MINIMALLY INVASIVE UROLOGY CENTER, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MINIMALLY INVASIVE UROLOGY CENTER, PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356640486
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
#576 CESAR GONZALEZ STREET
Provider Second Line Business Mailing Address:
ADLER MEDICAL PLAZA, SUITE 304
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-250-8985
Provider Business Mailing Address Fax Number:
787-764-6439

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ADLER MEDICAL PLAZA, SUITE 304
Provider Second Line Business Practice Location Address:
576 CESAR GONZALEZ AVENUE
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-250-8985
Provider Business Practice Location Address Fax Number:
787-764-6439
Provider Enumeration Date:
03/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
COLON-HERDMAN
Authorized Official First Name:
ARTURO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-250-8985

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  15396 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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