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General NPI Number Information
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NPI Number | 1164893525
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Entity Type | Organization
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Legal Business Name | UROCENTRO DEL SUR, LLC
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Dates
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Enumeration Date | 10/12/2015
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Last Update Date | 09/20/2018
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Provider Practice Location Address
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Address Line | TORRE MED SAN LUCAS SUITE 16 909 TITO CASTRO AVE
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City | PONCE
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State | PR
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Zip | 00716-4728
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Country | US
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Telephone | 787-840-6290
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Fax | 787-840-6299
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Provider Business Mailing Address
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Address Line | PO BOX 123
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City | PONCE
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State | PR
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Zip | 00715-0123
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Country | US
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Telephone | 787-840-6290
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Fax | 787-840-6299
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GILBERTO RUIZ DEYA
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Credential | MD
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Telephone | 787-840-6290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 356214
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License Number State | PR
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