Provider Demographics
NPI:1477913556
Name:PONCE PLASTIC SURGERY AND PAIN MANAGEMENT CENTER CORP
Entity Type:Organization
Organization Name:PONCE PLASTIC SURGERY AND PAIN MANAGEMENT CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-840-1114
Mailing Address - Street 1:909 AVE TITO CASTRO STE 805
Mailing Address - Street 2:TORRE MEDICA SAN LUCAS
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-4725
Mailing Address - Country:US
Mailing Address - Phone:787-840-1114
Mailing Address - Fax:787-842-6661
Practice Address - Street 1:909 AVE TITO CASTRO STE 805
Practice Address - Street 2:909 AVE TITO CASTRO SUITE #805
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4725
Practice Address - Country:US
Practice Address - Phone:787-840-1114
Practice Address - Fax:787-842-6661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR38261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical