Provider Demographics
NPI:1356764278
Name:PUERTO RICO UROLOGY GROUP LLC
Entity type:Organization
Organization Name:PUERTO RICO UROLOGY GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMAN TORREGUITART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-834-8160
Mailing Address - Street 1:PO BOX 350
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0350
Mailing Address - Country:US
Mailing Address - Phone:787-834-8160
Mailing Address - Fax:787-265-5777
Practice Address - Street 1:103 CALLE DE DIEGO E
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4863
Practice Address - Country:US
Practice Address - Phone:787-834-8160
Practice Address - Fax:787-265-5777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty