Provider Demographics
NPI:1396877619
Name:CENTRO UROLOGICO DEL OESTE
Entity type:Organization
Organization Name:CENTRO UROLOGICO DEL OESTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ITURREGUI-PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-833-6295
Mailing Address - Street 1:30 CONDOMINIO SOLIMAR, APT 2A
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-8309
Mailing Address - Country:US
Mailing Address - Phone:787-335-9208
Mailing Address - Fax:787-265-3952
Practice Address - Street 1:AVE HOSTOS
Practice Address - Street 2:CENTRO MEDICO DE MAYAGUEZ
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-6353
Practice Address - Country:US
Practice Address - Phone:787-335-9208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4364208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR340697OtherACAA
PR3668OtherFIRST MEDICAL
PR=========OtherCLASSICARE
PR3668OtherFIRST MEDICAL
PR=========OtherAARP
PR=========OtherMMM
PR=========OtherTRICARE
PR=========OtherGHI
PR=========OtherCOSVI
PR=========OtherCIGNA
PR=========OtherBELLA VISTA
PR=========OtherGHI
PRE08214Medicare UPIN