Healthcare Provider Details

I. General information

NPI: 1689200149
Provider Name (Legal Business Name): CENTRO AMBULATORIO DE CIRUGIA ESPECIALIZADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 AVE TITO CASTRO
PONCE PR
00716-4717
US

IV. Provider business mailing address

PO BOX 1715
LAJAS PR
00667-1715
US

V. Phone/Fax

Practice location:
  • Phone: 787-284-8800
  • Fax:
Mailing address:
  • Phone: 787-840-6290
  • Fax: 787-899-8023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERTO I RUIZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-249-5097