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General NPI Number Information
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NPI Number | 1659702199
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Entity Type | Organization
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Legal Business Name | SERVICIOS UROLOGICOS DE PUERTO RICO
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Dates
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Enumeration Date | 12/10/2013
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 735 AVE PONCE DE LEON TORRE MEDICA AUXILIO MUTUO SUITE 409
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City | SAN JUAN
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State | PR
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Zip | 00917-5022
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Country | US
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Telephone | 787-753-8514
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Fax | 787-753-2883
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Provider Business Mailing Address
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Address Line | 35 CALLE JUAN C BORBON SUITE 67-195
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City | GUAYNABO
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State | PR
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Zip | 00969-5374
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Country | US
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Telephone | 787-753-8514
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Fax | 787-753-2883
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GIL NIEVES LATIMER
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Credential |
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Telephone | 787-753-8514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 599143713
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State | PR
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Taxonomy #5
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State | PR
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Taxonomy #6
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State | PR
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