Provider Demographics
NPI:1659813186
Name:DISPENSARIO DE UTUADO
Entity Type:Organization
Organization Name:DISPENSARIO DE UTUADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:H
Authorized Official - Last Name:PADRO ROSADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-894-8332
Mailing Address - Street 1:PO BOX 571
Mailing Address - Street 2:
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641-0571
Mailing Address - Country:US
Mailing Address - Phone:787-894-8332
Mailing Address - Fax:787-894-1234
Practice Address - Street 1:39 AVE FERNANDO RIBAS
Practice Address - Street 2:
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641-2300
Practice Address - Country:US
Practice Address - Phone:787-894-8332
Practice Address - Fax:787-894-1234
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORPORACION DEL FONDO DEL SEGURO DEL ESTADO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR80261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local