Healthcare Provider Details

I. General information

NPI: 1427698208
Provider Name (Legal Business Name): PUERTO RICO ADVANCED UROLOGY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 11/27/2023
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 AVE LAUREL
BAYAMON PR
00956-4816
US

IV. Provider business mailing address

PO BOX 1847
BAYAMON PR
00960-1847
US

V. Phone/Fax

Practice location:
  • Phone: 787-786-5307
  • Fax: 787-740-2140
Mailing address:
  • Phone: 787-786-5305
  • Fax: 787-740-2140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QL0400X
TaxonomyLithotripsy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. FRANCISCO MANUEL DUBOCQ
Title or Position: DIRECTOR
Credential: MD
Phone: 787-948-3431