Provider Demographics
NPI:1548660939
Name:RECINTO DE BAYAMON UPR
Entity type:Organization
Organization Name:RECINTO DE BAYAMON UPR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:N
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-993-8965
Mailing Address - Street 1:170 CARR. 174
Mailing Address - Street 2:PARQUE INDUSTRIAL MINILLAS
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-1911
Mailing Address - Country:US
Mailing Address - Phone:787-993-8965
Mailing Address - Fax:787-993-8933
Practice Address - Street 1:170 CARR. 174
Practice Address - Street 2:PARQUE INDUSTRIAL MINILLAS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-1911
Practice Address - Country:US
Practice Address - Phone:787-993-0000
Practice Address - Fax:787-993-8933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health