Healthcare Provider Details

I. General information

NPI: 1205855228
Provider Name (Legal Business Name): POLICLINICAS DE PONCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZOLETA PONCE CASH & CARRY LOCAL 4 MORELL CAMPOS MORREL CAMPOS
PONCE PR
00732-7105
US

IV. Provider business mailing address

PMB 261 PO BOX 7105 MORREL CAMPOS
PONCE PR
00732-7105
US

V. Phone/Fax

Practice location:
  • Phone: 787-812-3153
  • Fax: 787-290-6689
Mailing address:
  • Phone: 787-812-3153
  • Fax: 787-290-6689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. EFRAIN GONZALEZ DROZ
Title or Position: ADMINISTRADOR MEDICO
Credential: MD
Phone: 787-812-3193