=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063186179
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTER AMERICAN UNIVERSITY OF PUERTO RICO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2021
-----------------------------------------------------
Last Update Date | 08/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | AVENIDA UNIVERSIDAD INTERAMERICANA CARR. 102 KM 30 HM 6
-----------------------------------------------------
City | SAN GERMAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-264-1912
-----------------------------------------------------
Fax | 787-264-0220
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5100
-----------------------------------------------------
City | SAN GERMAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00683-9801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-264-1912
-----------------------------------------------------
Fax | 787-264-0220
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AYUDANTE EJECUTIVA
-----------------------------------------------------
Name | TARY GARCIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-264-1912
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------