1902171929 NPI number — CENTRO DE CIRUGIA UROLOGICA AMBULATORIA, LLC

Table of content: (NPI 1902171929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902171929 NPI number — CENTRO DE CIRUGIA UROLOGICA AMBULATORIA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO DE CIRUGIA UROLOGICA AMBULATORIA, LLC
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:
CENTRO DE CIRUGIA UROLOGICA AMBULATORIA
Provider Other Organization Name Type Code:
3
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:
1902171929
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1847
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00960-1847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-786-5305
Provider Business Mailing Address Fax Number:
787-740-2140

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
68 CALLE SANTA CRUZ
Provider Second Line Business Practice Location Address:
TORRE SAN PABLO, SUITE 102
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00961-7031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-786-5305
Provider Business Practice Location Address Fax Number:
787-740-2140
Provider Enumeration Date:
03/09/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DUBOCQ-BERDEGUEZ
Authorized Official First Name:
FRANCISCO
Authorized Official Middle Name:
MANUEL
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
787-786-5305

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , 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)

  • Identifier: 037492600 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 25 . This is a "PR DEPT OF HEALTH - SARAFS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".