Healthcare Provider Details

I. General information

NPI: 1134244577
Provider Name (Legal Business Name): RECINTO UNIVERSITARIO DE MAYAGUEZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 ALFONSO VALDEZ BLVD. HEALTH SERVICES DEPARTMENT RUM
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

PO BOX 9000
MAYAGUEZ PR
00681-9000
US

V. Phone/Fax

Practice location:
  • Phone: 787-265-3865
  • Fax: 787-834-1538
Mailing address:
  • Phone: 787-832-4040
  • Fax: 787-834-1538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number37
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number37
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number37
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number37
License Number StatePR
# 5
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number37
License Number StatePR
# 6
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number37
License Number StatePR
# 7
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number37
License Number StatePR
# 8
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number37
License Number StatePR
# 9
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number330
License Number StatePR
# 10
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number37
License Number StatePR
# 11
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number37
License Number StatePR

VIII. Authorized Official

Name: DR. JORGE I RIVERA SANTOS
Title or Position: CHANCELLOR
Credential: PHD
Phone: 787-832-4040