Provider Demographics
NPI:1659702199
Name:SERVICIOS UROLOGICOS DE PUERTO RICO
Entity Type:Organization
Organization Name:SERVICIOS UROLOGICOS DE PUERTO RICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GIL
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEVES LATIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-753-8514
Mailing Address - Street 1:35 CALLE JUAN C BORBON
Mailing Address - Street 2:SUITE 67-195
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5374
Mailing Address - Country:US
Mailing Address - Phone:787-753-8514
Mailing Address - Fax:787-753-2883
Practice Address - Street 1:735 AVE PONCE DE LEON
Practice Address - Street 2:TORRE MEDICA AUXILIO MUTUO SUITE 409
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5022
Practice Address - Country:US
Practice Address - Phone:787-753-8514
Practice Address - Fax:787-753-2883
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SERVICIOS UROLOGICOS DE PUERTO RICO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR208800000X, 302R00000X, 305R00000X, 305S00000X
PR599143713302F00000X
305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of ServiceGroup - Single Specialty