=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043208804
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PONCE MEDICAL SCHOOL FOUNDATION INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2005
-----------------------------------------------------
Last Update Date | 08/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CALLE ANA D PEREZ MARSHAND, LOTE 2 BY PASS ANTIGUA CLINICA DE VETERANOS URB INDUSTRIAL REPARADA
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00732-7004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-840-0052
-----------------------------------------------------
Fax | 787-840-2317
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7004
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00732-7004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-840-0052
-----------------------------------------------------
Fax | 787-840-2317
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENTE
-----------------------------------------------------
Name | DR. RAUL ARMSTRONG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 787-840-0052
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------