Healthcare Provider Details

I. General information

NPI: 1265701247
Provider Name (Legal Business Name): UNIVERSIDAD CENTRAL DEL CARIBE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDA LAUREL ESQUINA SANTA JUANITA #100
BAYAMON PR
00960
US

IV. Provider business mailing address

PO BOX 60327
BAYAMON PR
00960
US

V. Phone/Fax

Practice location:
  • Phone: 787-798-3001
  • Fax: 787-778-0460
Mailing address:
  • Phone: 787-798-3001
  • Fax: 787-778-0460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JOSE G. RODRIGUEZ IRIZARRY
Title or Position: PRESIDENT UCC
Credential:
Phone: 787-798-3001