Provider Demographics
NPI:1154306959
Name:POLICLINICAS DE PONCE
Entity Type:Organization
Organization Name:POLICLINICAS DE PONCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:EFRAIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GONZALEZ DROZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-848-1293
Mailing Address - Street 1:PMB 261
Mailing Address - Street 2:PO BOX 7105
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732
Mailing Address - Country:US
Mailing Address - Phone:787-812-1293
Mailing Address - Fax:787-290-6689
Practice Address - Street 1:PLAZOLETA MORELL CAMPOS PONCE CASH & CARRY
Practice Address - Street 2:LOCAL #4
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00732
Practice Address - Country:US
Practice Address - Phone:787-812-3193
Practice Address - Fax:787-290-6689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR05B2134261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
80322Medicare ID - Type Unspecified
80321Medicare ID - Type Unspecified