Healthcare Provider Details

I. General information

NPI: 1841511953
Provider Name (Legal Business Name): MUNICIPIO DE PONCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE CRISTINA 4015
PONCE PR
00733
US

IV. Provider business mailing address

PO BOX 331709 DEPARTAMENTO DE SALUD CENTRO DE VACUNACION MUNICIPAL
PONCE PR
00733-1709
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-8624
  • Fax: 787-840-8638
Mailing address:
  • Phone: 787-840-8624
  • Fax: 787-840-8638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberTCAMB394
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLOS JUAN MAYOL SR.
Title or Position: MUNICIPAL HELTH DEPT DIRECTOR
Credential: MD,MPH
Phone: 787-840-8624