Provider Demographics
NPI:1164893525
Name:UROCENTRO DEL SUR, LLC
Entity Type:Organization
Organization Name:UROCENTRO DEL SUR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ DEYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-840-6290
Mailing Address - Street 1:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0123
Mailing Address - Country:US
Mailing Address - Phone:787-840-6290
Mailing Address - Fax:787-840-6299
Practice Address - Street 1:TORRE MED SAN LUCAS SUITE 16
Practice Address - Street 2:909 TITO CASTRO AVE
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4728
Practice Address - Country:US
Practice Address - Phone:787-840-6290
Practice Address - Fax:787-840-6299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR356214174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty