Provider Demographics
NPI:1205618048
Name:INTER AMERICAN UNIVERSITY OF PUERTO RICO
Entity type:Organization
Organization Name:INTER AMERICAN UNIVERSITY OF PUERTO RICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEAN
Authorized Official - Prefix:
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 CARR DR. JOHN WILL HARRIS
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957-6257
Mailing Address - Country:US
Mailing Address - Phone:787-765-1915
Mailing Address - Fax:787-765-9854
Practice Address - Street 1:AVE. EL JIBARO CARR. 172 KM 135
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-739-8182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-17
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR037652204Medicaid