Healthcare Provider Details

I. General information

NPI: 1902171929
Provider Name (Legal Business Name): CENTRO DE CIRUGIA UROLOGICA AMBULATORIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2012
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 CALLE SANTA CRUZ TORRE SAN PABLO, SUITE 102
BAYAMON PR
00961-7031
US

IV. Provider business mailing address

PO BOX 1847
BAYAMON PR
00960-1847
US

V. Phone/Fax

Practice location:
  • Phone: 787-786-5305
  • 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 StatePR

VIII. Authorized Official

Name: DR. FRANCISCO MANUEL DUBOCQ-BERDEGUEZ
Title or Position: DIRECTOR
Credential: M.D.
Phone: 787-786-5305