Provider Demographics
NPI:1083977920
Name:PUERTO RICO RENAL HEALTH & RESEARCH
Entity Type:Organization
Organization Name:PUERTO RICO RENAL HEALTH & RESEARCH
Other - Org Name:CKD -PONCE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRIMARY NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:787-710-2532
Mailing Address - Street 1:AVE.TITO CASTRO 609
Mailing Address - Street 2:SUITE 102 PBM 380
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2232
Mailing Address - Country:US
Mailing Address - Phone:787-710-2532
Mailing Address - Fax:787-843-5252
Practice Address - Street 1:609 AVE.TITO CASTRO
Practice Address - Street 2:SUITE 102 PBM 380
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-0200
Practice Address - Country:US
Practice Address - Phone:787-710-2532
Practice Address - Fax:787-843-5252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1041C0700X261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service