1235347725 NPI number — PROFESSIONAL UROLOGIC CONSULTANTS PSC

Table of content: (NPI 1235347725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235347725 NPI number — PROFESSIONAL UROLOGIC CONSULTANTS PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROFESSIONAL UROLOGIC CONSULTANTS 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:
1235347725
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CARR 21 T 3 8 LAS LOMAS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-781-1265
Provider Business Mailing Address Fax Number:
787-812-0565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CAMINO LOS BAEZ
Provider Second Line Business Practice Location Address:
CON EL BOSQUE APT 1608
Provider Business Practice Location Address City Name:
GUAYNABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00971-9632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-461-7147
Provider Business Practice Location Address Fax Number:
787-812-0565
Provider Enumeration Date:
05/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AMBERT
Authorized Official First Name:
LUIS
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-461-7147

Provider Taxonomy Codes

  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com