Provider Demographics
NPI:1679159057
Name:INTER AMERICAN UNIVERSITY OF PUERTO RICO, GUAYAMA CAMPUS
Entity Type:Organization
Organization Name:INTER AMERICAN UNIVERSITY OF PUERTO RICO, GUAYAMA CAMPUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHANCELLOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:787-864-2222
Mailing Address - Street 1:PO BOX 10004
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-4004
Mailing Address - Country:US
Mailing Address - Phone:787-864-2222
Mailing Address - Fax:787-866-5006
Practice Address - Street 1:BO. MACHETE
Practice Address - Street 2:CARR. 744 KM 1.2
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-0078
Practice Address - Country:US
Practice Address - Phone:787-864-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory