Healthcare Provider Details

I. General information

NPI: 1699004366
Provider Name (Legal Business Name): CARIBBEAN UROGYNECOLOGY ASSOCIATES PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 AVE SAN PATRICIO MARAMAR PLAZA SUITE 1090
GUAYNABO PR
00968-2645
US

IV. Provider business mailing address

101 AVE SAN PATRICIO MARAMAR PLAZA SUITE 1090
GUAYNABO PR
00968-2645
US

V. Phone/Fax

Practice location:
  • Phone: 787-414-8777
  • Fax: 787-963-0729
Mailing address:
  • Phone: 787-414-8777
  • Fax: 787-963-0729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number16233
License Number StatePR

VIII. Authorized Official

Name: DR. JIMMY J JULIA-MARTINEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-414-8777