Healthcare Provider Details

I. General information

NPI: 1942325261
Provider Name (Legal Business Name): POLICLINICAS DE PONCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PMB 261 APTDO 7105 PMB 261 APTDO 7105
PONCE PR
00732-7105
US

IV. Provider business mailing address

GLENVIEW GARDENS SHOPPING CENTER 4 LOCAL
PONCE PR
00731
US

V. Phone/Fax

Practice location:
  • Phone: 787-812-3193
  • Fax:
Mailing address:
  • Phone: 787-812-3153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EFRAIN GONZALEZ DROZ
Title or Position: PRESIDENTE
Credential: MD
Phone: 787-812-3153