Provider Demographics
NPI:1912333527
Name:RADA UROLOGICAL CONSULTING PSC
Entity Type:Organization
Organization Name:RADA UROLOGICAL CONSULTING PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENAN
Authorized Official - Middle Name:ARIEL
Authorized Official - Last Name:DIEPPA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-751-3535
Mailing Address - Street 1:PO BOX 363704
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-3704
Mailing Address - Country:US
Mailing Address - Phone:787-751-3535
Mailing Address - Fax:787-767-6111
Practice Address - Street 1:982 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:787-751-3535
Practice Address - Fax:787-767-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR208800000X, 2088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Single Specialty