Provider Demographics
NPI:1962847632
Name:UNIVERSIDAD DE PUERTO RICO
Entity Type:Organization
Organization Name:UNIVERSIDAD DE PUERTO RICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLAZO GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-447-5200
Mailing Address - Street 1:PO BOX 444
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-0444
Mailing Address - Country:US
Mailing Address - Phone:787-447-5200
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSIDAD DE PUERTO RICO
Practice Address - Street 2:DEPARTAMENTO MEDICINA 8VO PISO A- 838
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935-0001
Practice Address - Country:US
Practice Address - Phone:787-759-8252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital