Provider Demographics
NPI:1780963546
Name:CIUDAD UNIVERSITARIA MEDICAL, C.S.P.
Entity type:Organization
Organization Name:CIUDAD UNIVERSITARIA MEDICAL, C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:HIRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PABON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-412-6241
Mailing Address - Street 1:PO BOX 3185
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-3185
Mailing Address - Country:US
Mailing Address - Phone:787-755-5515
Mailing Address - Fax:
Practice Address - Street 1:AVE AA D 14 CIUDAD UNIVERSITARIA
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00977
Practice Address - Country:US
Practice Address - Phone:787-755-5515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15712208D00000X
PR16514208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty