Provider Demographics
NPI:1841511953
Name:MUNICIPIO DE PONCE
Entity type:Organization
Organization Name:MUNICIPIO DE PONCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MUNICIPAL HELTH DEPT DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:JUAN
Authorized Official - Last Name:MAYOL
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD,MPH
Authorized Official - Phone:787-840-8624
Mailing Address - Street 1:PO BOX 331709
Mailing Address - Street 2:DEPARTAMENTO DE SALUD CENTRO DE VACUNACION MUNICIPAL
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00733-1709
Mailing Address - Country:US
Mailing Address - Phone:787-840-8624
Mailing Address - Fax:787-840-8638
Practice Address - Street 1:CALLE CRISTINA 4015
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00733
Practice Address - Country:US
Practice Address - Phone:787-840-8624
Practice Address - Fax:787-840-8638
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUNICIPIO AUTONOMO DE PONCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-14
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTCAMB3943416L0300X
261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No3416L0300XTransportation ServicesAmbulanceLand Transport