MEDICARE: UNIVERSITY OF PUERTO RICO SCHOOL OF MEDICINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	12985I	PR

General Provider Information

NPI Number	:	1750655510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF PUERTO RICO SCHOOL OF MEDICINE

Provider Business Mailing Address
First Line	:	U20 JASPER STREET
Second Line	:	PARK GARDENS URB.
City	:	SAN JUAN
State	:	PR
Zip	:	00936-9321
Country	:	US
Telephone Number	:	787-759-8252
Fax Number	:

Provider Business Practice Location Address
First Line	:	U20 CALLE JASPER
Second Line	:	PARK GARDENS URB.
City	:	SAN JUAN
State	:	PR
Zip	:	00926-2139
Country	:	US
Telephone Number	:	787-759-8252
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR IN MEDICINE
Name	:	DR. KILSY ALEXANDRA CUELLO PICHARDO
Credential	:	M.D.
Telephone Number	:	787-292-2018

Provider Enumeration Date	:	02/26/2012
Last Update Date	:	02/26/2012

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