Basic Information
| Provider Information | |||||||||
| NPI: | 1851527154 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PUERTO RICO METROPOLITAN UROLOGY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | ROAD 21 T3-8 | ||||||||
| Address2: | URB. LAS LOMAS | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009210000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877811265 | ||||||||
| FaxNumber: | 7877813131 | ||||||||
| Practice Location | |||||||||
| Address1: | CA. SERGIO CUEVAS BUSTAMANTE #550 | ||||||||
| Address2: | HOSPITAL DEL MAESTRO SUITE 2001 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009180000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877637277 | ||||||||
| FaxNumber: | 7877813131 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2009 | ||||||||
| LastUpdateDate: | 03/25/2011 | ||||||||
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| AuthorizedOfficialLastName: | BOUET BLASINI | ||||||||
| AuthorizedOfficialFirstName: | RAFAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CO- PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7875106893 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 15374 | PR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.