Provider Demographics
NPI:1013916147
Name:INTER AMERICAN UNIVERSITY OF PUERTO RICO
Entity Type:Organization
Organization Name:INTER AMERICAN UNIVERSITY OF PUERTO RICO
Other - Org Name:UNIVERSIDAD INTERAMERICANA DE PUERTO RICO
Other - Org Type:Other Name
Authorized Official - Title/Position:DEAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-765-1915
Mailing Address - Street 1:500 JOHN WILL HARRIS AVE.
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957
Mailing Address - Country:US
Mailing Address - Phone:787-765-1915
Mailing Address - Fax:787-765-9854
Practice Address - Street 1:500 JOHN WILL HARRIS AVE.
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-765-1915
Practice Address - Fax:787-767-3929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRACADEMIC INSTITUTION152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherMCS
9180250OtherHUMANA INSURANCE
=========OtherCOSVIMED
=========BOtherMCS
PR50080Medicare ID - Type Unspecified
PR10592Medicare ID - Type Unspecified
7250242OtherHUMANA INSURANCE
890105OtherMMM
PR50081Medicare ID - Type Unspecified
1310510001OtherPALME H O
077146OtherLA CRUZ AZRA PR
1310510004OtherPALME H O
PR50079Medicare ID - Type Unspecified
PR50082Medicare ID - Type Unspecified
1310510002OtherPALME H O
215104OtherPREFERRED HEALTH
7800020OtherHUMANA INSURANCE
9230041OtherHUMANA INSURANCE
=========AOtherMCS
PR10392Medicare ID - Type Unspecified