Basic Information
| Provider Information | |||||||||
| NPI: | 1841684701 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | A.L.U. SOLIDARIDAD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 151PONCE DE LEON AVE | ||||||||
| Address2: | FIRST FEDERAL SAVING BUILDING 1201 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877213444 | ||||||||
| FaxNumber: | 7877213458 | ||||||||
| Practice Location | |||||||||
| Address1: | 1519 AVE PONCE DE LEON | ||||||||
| Address2: | FIRST FEDERAL SAVING BUILDING SUITE 1201 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009091703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877213444 | ||||||||
| FaxNumber: | 7877213458 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2015 | ||||||||
| LastUpdateDate: | 03/27/2015 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SANTIAGO | ||||||||
| AuthorizedOfficialFirstName: | UBALDO | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7877213444 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 305R00000X | Y | Managed Care Organizations | Preferred Provider Organization |
ID Information
| ID | Type | State | Issuer | Description | 5086 | 01 | PR | REGISTRO | OTHER | 10764 | 01 | PR | AMP | OTHER |