Healthcare Provider Details

I. General information

NPI: 1083459580
Provider Name (Legal Business Name): PUERTO RICO EMERGENCY MEDICINE ULTRASOUND SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 AVE TITO CASTRO
PONCE PR
00716-4717
US

IV. Provider business mailing address

105 ARTERIAL HOSTOS BAYSIDE COVE, APT 127
SAN JUAN PR
00918
US

V. Phone/Fax

Practice location:
  • Phone: 787-844-2080
  • Fax:
Mailing address:
  • Phone: 787-381-4076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CARLOS ALEJANDRO FRANCISCO GONZALEZ COBOS
Title or Position: EMPLOYEE
Credential: MD
Phone: 787-381-4076