Basic Information
| Provider Information | |||||||||
| NPI: | 1790993400 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARIBBEAN URO-SURGICAL PROCEDURES PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | CAMINO LOS BAEZ | ||||||||
| Address2: | COND EL BOSQUE APT 1608 | ||||||||
| City: | GUAYNABO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009719632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874617147 | ||||||||
| FaxNumber: | 7878120565 | ||||||||
| Practice Location | |||||||||
| Address1: | CARR 21 T 3 8 LAS LOMAS | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874617147 | ||||||||
| FaxNumber: | 7878120565 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | AMBERT | ||||||||
| AuthorizedOfficialFirstName: | LUIS | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7874617147 | ||||||||
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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 | 208800000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.