Provider Demographics
NPI:1043208804
Name:PONCE MEDICAL SCHOOL FOUNDATION INC
Entity Type:Organization
Organization Name:PONCE MEDICAL SCHOOL FOUNDATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-840-0052
Mailing Address - Street 1:PO BOX 7004
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7004
Mailing Address - Country:US
Mailing Address - Phone:787-840-0052
Mailing Address - Fax:787-840-2317
Practice Address - Street 1:CALLE ANA D PEREZ MARSHAND, LOTE 2 BY PASS
Practice Address - Street 2:ANTIGUA CLINICA DE VETERANOS URB INDUSTRIAL REPARADA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00732-7004
Practice Address - Country:US
Practice Address - Phone:787-840-0052
Practice Address - Fax:787-840-2317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0010390Medicare PIN