Healthcare Provider Details

I. General information

NPI: 1972517951
Provider Name (Legal Business Name): PONCE MEDICAL SCHOOL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL RAMON E. BETANCES EDIFICIO PRINCIPAL CARR #2
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

PO BOX 7004
PONCE PR
00732-7004
US

V. Phone/Fax

Practice location:
  • Phone: 787-832-3040
  • Fax: 787-832-0305
Mailing address:
  • Phone: 787-840-2575
  • Fax: 787-840-8391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. HECTOR BURGOS
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 787-840-2575