Healthcare Provider Details

I. General information

NPI: 1831506344
Provider Name (Legal Business Name): GO GOGO FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 CALLE MONTERREY URB. INDUSTRIAL REPARADA
PONCE PR
00716-0376
US

IV. Provider business mailing address

291 MONTERREY ST. URB. INDUSTRIAL REPARADA
PONCE PR
00716
US

V. Phone/Fax

Practice location:
  • Phone: 787-651-7003
  • Fax:
Mailing address:
  • Phone: 787-651-7003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. UISES CLAVELL
Title or Position: PRESIDENT
Credential:
Phone: 787-974-2679