Healthcare Provider Details

I. General information

NPI: 1306112792
Provider Name (Legal Business Name): UNIVERSIDAD DE PUERTO RICO DE CAYEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE ANTONIO R BARCELO 205
CAYEY PR
00736
US

IV. Provider business mailing address

AVE ANTONIO R BARCELO 205
CAYEY PR
00736
US

V. Phone/Fax

Practice location:
  • Phone: 787-738-2161
  • Fax:
Mailing address:
  • Phone: 787-738-2161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSE COLON
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 787-738-2161