Provider Demographics
NPI:1205068988
Name:UNIVERSITY OF PUERTO RICO AT MAYAGUEZ
Entity type:Organization
Organization Name:UNIVERSITY OF PUERTO RICO AT MAYAGUEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCES DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
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:787-834-1980
Practice Address - Street 1:259 ALFONSO VALDES BOULEVARD
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-832-4040
Practice Address - Fax:787-834-1980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-14
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR90103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty