Provider Demographics
NPI:1831318369
Name:POLICLINICAS DE PONCE
Entity Type:Organization
Organization Name:POLICLINICAS DE PONCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICO PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:EFRAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ-DYOZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-812-3193
Mailing Address - Street 1:261 PMB 7105
Mailing Address - Street 2:MORELL CAMPOS
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7105
Mailing Address - Country:US
Mailing Address - Phone:787-812-3193
Mailing Address - Fax:
Practice Address - Street 1:261 PMB 7105
Practice Address - Street 2:MORELL CAMPOS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00732-7105
Practice Address - Country:US
Practice Address - Phone:787-812-3193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10515OtherCENTRO VACUNACION