Basic Information
| Provider Information | |||||||||
| NPI: | 1497766018 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIV. CENTRAL DEL CARIBE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60307 | ||||||||
| Address2: | |||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009606030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877983001 | ||||||||
| FaxNumber: | 7877780460 | ||||||||
| Practice Location | |||||||||
| Address1: | AVENIDA LAUREL | ||||||||
| Address2: | ESQUINA SANTA JUANITA #100 | ||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877983001 | ||||||||
| FaxNumber: | 7877780460 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CANDELARIO-FERNANDEO | ||||||||
| AuthorizedOfficialFirstName: | NILDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/ UCC | ||||||||
| AuthorizedOfficialTelephone: | 7877983001 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0205X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
ID Information
| ID | Type | State | Issuer | Description | 9560099 | 01 | HUMANA | OTHER | 0773 | 01 | INTERNATIONAL MED. CARD | OTHER | 84774 | 01 | SSS | OTHER | 6919067 | 01 | CIGNA | OTHER | 060890 | 01 | CRUZ AZUL | OTHER |