Healthcare Provider Details

I. General information

NPI: 1871609610
Provider Name (Legal Business Name): ENDOUROLOGICAL INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 09/13/2023
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ENDOUROLOGICAL INSTITUTE INC-CENTRO CIRUGIA AMBULATORIA 735 AVE PONCE DE LEON SUITE 608-612 TORRE AUXILIO MUTUO
SAN JUAN PR
00917-5028
US

IV. Provider business mailing address

755 AVENIDA PONCE DE LEON TORRE DE AUXILIO MUTUO SUITE 608
SAN JUAN PR
00917-5028
US

V. Phone/Fax

Practice location:
  • Phone: 787-777-8181
  • Fax: 787-777-8180
Mailing address:
  • Phone: 787-777-8181
  • Fax: 787-777-8180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number14
License Number StatePR

VIII. Authorized Official

Name: PABLO E CARDONA DOBLE
Title or Position: PRESIDENT ENDOUROLOGICAL INSTITUTE
Credential: MD
Phone: 787-777-8181