Healthcare Provider Details

I. General information

NPI: 1144234147
Provider Name (Legal Business Name): PONCE SCHOOL OF MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. HOSPITAL # 15
OROCOVIS PR
00720
US

IV. Provider business mailing address

PO BOX 7004
PONCE PR
00732-7004
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-2575
  • Fax: 787-840-8391
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: HECTOR BURGOS
Title or Position: OPERATIONS MANAGER
Credential: MBA
Phone: 787-840-2575