Basic Information
| Provider Information | |||||||||
| NPI: | 1861403487 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIV CENTRAL DEL CARIBE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60327 | ||||||||
| Address2: | |||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009606032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877983001 | ||||||||
| FaxNumber: | 7877780460 | ||||||||
| Practice Location | |||||||||
| Address1: | AVENIDA LAUREL | ||||||||
| Address2: | ESQUINA SANTA JUANITA | ||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877983001 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | CANDELARIO-FERNANDEZ | ||||||||
| AuthorizedOfficialFirstName: | NILDA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENTE | ||||||||
| AuthorizedOfficialTelephone: | 7877983001 | ||||||||
| IsSoleProprietor: | |||||||||
| 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 | 207N00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 84782 | 01 | SSS | OTHER | 9560087 | 01 | HUMANA | OTHER | 060890 | 01 | CRUZ AZUL | OTHER | 6919061 | 01 | CIGNA | OTHER |