Healthcare Provider Details

I. General information

NPI: 1891125373
Provider Name (Legal Business Name): UROLOGY AMBULATORY SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDA LAS AMERICAS HOSPITAL DR. PILA
PONCE PR
00780
US

IV. Provider business mailing address

PO BOX 2908
GUAYAMA PR
00785-2908
US

V. Phone/Fax

Practice location:
  • Phone: 787-848-6910
  • Fax: 787-709-4730
Mailing address:
  • Phone: 787-866-3355
  • Fax: 787-905-7288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number014585
License Number StatePR

VIII. Authorized Official

Name: DR. ALBERTO CORICA GUINLE
Title or Position: OWNER
Credential: M.D.
Phone: 787-314-6821