# PONCE SCHOOL OF MEDICINE PRACTICE GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PSM Practice Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760583504
- **Authorized official:** HECTOR BURGOS (ADMINISTRATOR)
- **Authorized official phone:** (787) 614-2972

## Contact information

- **Practice address:** ANN D PEREZ MARSHAND ST LOTE 2, URB INDUSTRIAL REPARADA, PONCE, PR 00732-7004
- **Practice address phone:** (787) 840-0052
- **Practice address fax:** (787) 284-3619
- **Mailing address:** PO BOX 7004, PONCE SCHOOL OF MEDICINE PRACTICE GROUP, PONCE, PR 00732-7004
- **Mailing address phone:** (787) 840-0052
- **Mailing address fax:** (787) 840-2317

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | 4650E | PR | Yes |

## Other

- **Enumeration date:** 09/26/2006
- **Last updated:** 08/28/2008