Provider Demographics
NPI:1477957983
Name:DEPARTAMENTO DE SERVICIOS MEDICOS RECINTO UNIVERSITARIO DE MAYAGUEZ
Entity Type:Organization
Organization Name:DEPARTAMENTO DE SERVICIOS MEDICOS RECINTO UNIVERSITARIO DE MAYAGUEZ
Other - Org Name:SERVICIOS DENTALES
Other - Org Type:Other Name
Authorized Official - Title/Position:CHANCELLOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-832-4040
Mailing Address - Street 1:PO BOX 9000
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-9000
Mailing Address - Country:US
Mailing Address - Phone:787-832-4040
Mailing Address - Fax:
Practice Address - Street 1:259 AVE. ALFONSO VALDEZ
Practice Address - Street 2:DEPARTAMENTO SERVICIOS MEDICOS
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00681
Practice Address - Country:US
Practice Address - Phone:787-832-4040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RECINTO UNIVERSITARIO DE MAYAGUEZ
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental