Provider Demographics
NPI:1871609610
Name:ENDOUROLOGICAL INSTITUTE INC
Entity type:Organization
Organization Name:ENDOUROLOGICAL INSTITUTE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT ENDOUROLOGICAL INSTITUTE
Authorized Official - Prefix:
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARDONA DOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-777-8181
Mailing Address - Street 1:755 AVENIDA PONCE DE LEON
Mailing Address - Street 2:TORRE DE AUXILIO MUTUO SUITE 608
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-5028
Mailing Address - Country:US
Mailing Address - Phone:787-777-8181
Mailing Address - Fax:787-777-8180
Practice Address - Street 1:ENDOUROLOGICAL INSTITUTE INC-CENTRO CIRUGIA AMBULATORIA
Practice Address - Street 2:735 AVE PONCE DE LEON SUITE 608-612 TORRE AUXILIO MUTUO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5028
Practice Address - Country:US
Practice Address - Phone:787-777-8181
Practice Address - Fax:787-777-8180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
PR14261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038600400Medicaid
PR18038OtherTRIPLE S
PR600226OtherPREFERRED
PR9170053OtherHUMANA
PR030193OtherCRUZ AZUL
PR3602-2OtherPROSSAM
PR00344OtherAMERICAN HEALTH, INC.
PRLB-45464OtherUIA
PR600226OtherPREFERRED
PR=========-1OtherMEDICAL CARD SYSTEM
PR18038OtherTRIPLE S
PR9170053OtherHUMANA
PR=========OtherPALIC