Provider Demographics
NPI:1902817521
Name:UNIVERSIDAD CENTRAL DEL CARIBE
Entity Type:Organization
Organization Name:UNIVERSIDAD CENTRAL DEL CARIBE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT UCC
Authorized Official - Prefix:
Authorized Official - First Name:NILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANDELARIO-FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:782-798-3001
Mailing Address - Street 1:PO BOX 1786
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-1786
Mailing Address - Country:US
Mailing Address - Phone:787-269-0988
Mailing Address - Fax:787-995-6925
Practice Address - Street 1:AVENIDA LAUREL
Practice Address - Street 2:ESQUINA SANTA JUANITA #100
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-269-0988
Practice Address - Fax:787-995-6925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0083681OtherMEDICARE
9560077OtherHUMANA
83801OtherSSS
060890OtherCRUZ AZUL
9560077OtherHUMANA
=========OtherMAPFRE
=========OtherMMM
0083681OtherMEDICARE
060890OtherCRUZ AZUL
=========42OtherMEDICAL CARD SYSTEM