Healthcare Provider Details

I. General information

NPI: 1699228114
Provider Name (Legal Business Name): UNIVERSITY OF PUERTO RICO, MEDICAL SCIENCES CAMPUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF PUERTO RICO, MEDICAL SCIENCES CAMPUS
SAN JUAN PR
00936-5067
US

IV. Provider business mailing address

1026 AVE LUIS VIGOREAUX APT 11A
GUAYNABO PR
00966-2506
US

V. Phone/Fax

Practice location:
  • Phone: 787-763-2424
  • Fax:
Mailing address:
  • Phone: 973-474-6640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. ALANNA MARIA GUZMAN
Title or Position: GENERAL SURGERY RESIDENT
Credential: M.D., M.SC
Phone: 973-474-6640