Healthcare Provider Details

I. General information

NPI: 1659702199
Provider Name (Legal Business Name): SERVICIOS UROLOGICOS DE PUERTO RICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 AVE PONCE DE LEON TORRE MEDICA AUXILIO MUTUO SUITE 409
SAN JUAN PR
00917-5022
US

IV. Provider business mailing address

35 CALLE JUAN C BORBON SUITE 67-195
GUAYNABO PR
00969-5374
US

V. Phone/Fax

Practice location:
  • Phone: 787-753-8514
  • Fax: 787-753-2883
Mailing address:
  • Phone: 787-753-8514
  • Fax: 787-753-2883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number599143713
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number StatePR
# 6
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number StatePR

VIII. Authorized Official

Name: DR. GIL NIEVES LATIMER
Title or Position: PRESIDENT
Credential:
Phone: 787-753-8514