Healthcare Provider Details

I. General information

NPI: 1356764278
Provider Name (Legal Business Name): PUERTO RICO UROLOGY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2014
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 CALLE DE DIEGO E
MAYAGUEZ PR
00680-4863
US

IV. Provider business mailing address

PO BOX 350
MAYAGUEZ PR
00681-0350
US

V. Phone/Fax

Practice location:
  • Phone: 787-834-8160
  • Fax: 787-265-5777
Mailing address:
  • Phone: 787-834-8160
  • Fax: 787-265-5777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM ROMAN TORREGUITART
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-834-8160