Provider Demographics
NPI:1003189994
Name:PUERTO RICO COMMUNITY NETWORK FOR CLINICAL RESEARCH ON AIDS, INC.
Entity Type:Organization
Organization Name:PUERTO RICO COMMUNITY NETWORK FOR CLINICAL RESEARCH ON AIDS, INC.
Other - Org Name:PR CONCRA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-773-0464
Mailing Address - Street 1:1162 CALLE BRUMBAUGH
Mailing Address - Street 2:URB GARCIA UBARRI
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00925-3608
Mailing Address - Country:US
Mailing Address - Phone:787-773-0464
Mailing Address - Fax:787-294-1569
Practice Address - Street 1:1162 CALLE BRUMBAUGH
Practice Address - Street 2:URB GARCIA UBARRI
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00925-3608
Practice Address - Country:US
Practice Address - Phone:787-773-0464
Practice Address - Fax:787-294-1569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental