Healthcare Provider Details

I. General information

NPI: 1376999110
Provider Name (Legal Business Name): GO GOGO FOUNDATION CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 AVE HOSTOS
PONCE PR
00717-0952
US

IV. Provider business mailing address

PO BOX 801530
COTO LAUREL PR
00780-1530
US

V. Phone/Fax

Practice location:
  • Phone: 787-974-2679
  • Fax:
Mailing address:
  • Phone: 787-974-2679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. ULISES A. CLAVELL
Title or Position: DIRECTOR
Credential:
Phone: 787-974-2679