Provider Demographics
NPI:1356793525
Name:UNIVERSIDAD DE PR RUM
Entity type:Organization
Organization Name:UNIVERSIDAD DE PR RUM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR MEDICAL SERVICE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:N
Authorized Official - Last Name:PONCE
Authorized Official - Suffix:SR
Authorized Official - Credentials:MSH
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 AVE BLVD ALFONSO VALDEZ
Practice Address - Street 2:DEPTO SERVICIOS MEDICOS
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00681-9000
Practice Address - Country:US
Practice Address - Phone:787-832-4040
Practice Address - Fax:787-834-1538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR40D0684473291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherEMPLOYER IDENTIFICATION NUMBER