Provider Demographics
NPI:1518003276
Name:PUVA-TEK
Entity type:Organization
Organization Name:PUVA-TEK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALFONSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-753-3734
Mailing Address - Street 1:978 CALLE 42 SE
Mailing Address - Street 2:REPARTO METROPOLITANO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-2701
Mailing Address - Country:US
Mailing Address - Phone:787-753-3734
Mailing Address - Fax:787-753-3734
Practice Address - Street 1:978 CALLE 42 SE
Practice Address - Street 2:REPARTO METROPOLITANO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-2701
Practice Address - Country:US
Practice Address - Phone:787-753-3734
Practice Address - Fax:787-753-3734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0081056Medicare ID - Type Unspecified