Provider Demographics
NPI:1053466771
Name:TEACHERS ASSOCIATION OF PUERTO RICO
Entity Type:Organization
Organization Name:TEACHERS ASSOCIATION OF PUERTO RICO
Other - Org Name:PROSSAM (TEACHERS ASSOCIATION HEALTH SERVICES PROGRAM)
Other - Org Type:Other Name
Authorized Official - Title/Position:PROSSAM,DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-753-8591
Mailing Address - Street 1:PO BOX 191088
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-1088
Mailing Address - Country:US
Mailing Address - Phone:787-753-8591
Mailing Address - Fax:787-754-8854
Practice Address - Street 1:158 CALLE RAMOS ANTONINI E
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-5044
Practice Address - Country:US
Practice Address - Phone:787-831-3130
Practice Address - Fax:787-831-2676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0010098Medicare UPIN