=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154723450
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UROCARE PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2014
-----------------------------------------------------
Last Update Date | 09/18/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1452 AVE ASHFORD ADA LIGIA SUITE 1C
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00907-1581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-946-9788
-----------------------------------------------------
Fax | 787-963-0163
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1452 AVE ASHFORD ADA LIGIA SUITE 1C
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00907-1581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-946-9788
-----------------------------------------------------
Fax | 787-963-0163
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JOSE EDGARDO SILVA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 787-496-9788
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | 18720
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------