Provider Demographics
NPI:1194919589
Name:CLINICA DE UROLOGIA RECONSTRUCTIVA
Entity type:Organization
Organization Name:CLINICA DE UROLOGIA RECONSTRUCTIVA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCIAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-704-4141
Mailing Address - Street 1:GAUTIER BENITEZ AVE
Mailing Address - Street 2:SUITE C20-A
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-6539
Mailing Address - Country:US
Mailing Address - Phone:787-704-4141
Mailing Address - Fax:787-704-4144
Practice Address - Street 1:GAUTIER BENITEZ AVE.
Practice Address - Street 2:SUITE C20-A
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-704-4141
Practice Address - Fax:787-704-4144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12551208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty