Provider Demographics
NPI:1063710887
Name:UROFREEZE UROLOGY,CSP
Entity type:Organization
Organization Name:UROFREEZE UROLOGY,CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:P
Authorized Official - Last Name:CORICA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-866-3355
Mailing Address - Street 1:AVE PEDRO ALBIZU CAMPOS URB LA HACIENDA
Mailing Address - Street 2:HOSPITAL EPISCOPAL SAN LUCAS
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784
Mailing Address - Country:US
Mailing Address - Phone:787-866-3355
Mailing Address - Fax:787-864-6488
Practice Address - Street 1:HOSPITAL EPISCOPAL SAN LUCAS
Practice Address - Street 2:AVE PEDRO ALBIZU CAMPOS
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-866-3355
Practice Address - Fax:787-864-6488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization