Provider Demographics
NPI:1902171929
Name:CENTRO DE CIRUGIA UROLOGICA AMBULATORIA, LLC
Entity Type:Organization
Organization Name:CENTRO DE CIRUGIA UROLOGICA AMBULATORIA, LLC
Other - Org Name:CENTRO DE CIRUGIA UROLOGICA AMBULATORIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:DUBOCQ-BERDEGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-786-5305
Mailing Address - Street 1:PO BOX 1847
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-1847
Mailing Address - Country:US
Mailing Address - Phone:787-786-5305
Mailing Address - Fax:787-740-2140
Practice Address - Street 1:68 CALLE SANTA CRUZ
Practice Address - Street 2:TORRE SAN PABLO, SUITE 102
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7031
Practice Address - Country:US
Practice Address - Phone:787-786-5305
Practice Address - Fax:787-740-2140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-09
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR037492600Medicaid
PR25OtherPR DEPT OF HEALTH - SARAFS