Provider Demographics
NPI:1134244577
Name:RECINTO UNIVERSITARIO DE MAYAGUEZ
Entity type:Organization
Organization Name:RECINTO UNIVERSITARIO DE MAYAGUEZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHANCELLOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:I
Authorized Official - Last Name:RIVERA SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:787-832-4040
Mailing Address - Street 1:PO BOX 9000
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-9000
Mailing Address - Country:US
Mailing Address - Phone:787-832-4040
Mailing Address - Fax:787-834-1538
Practice Address - Street 1:259 ALFONSO VALDEZ BLVD.
Practice Address - Street 2:HEALTH SERVICES DEPARTMENT RUM
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-265-3865
Practice Address - Fax:787-834-1538
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RECINTO UNIVERSITARIO DE MAYAGUEZ
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-21
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR37208D00000X, 261Q00000X, 261QD0000X, 261QF0050X, 261QH0100X, 261QM0801X, 261QP2300X, 261QU0200X, 3416L0300X, 261QS1000X
PR330291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No291U00000XLaboratoriesClinical Medical Laboratory
No3416L0300XTransportation ServicesAmbulanceLand Transport