Basic Information
Provider Information | |||||||||
NPI: | 1245628445 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | RECINTO DE CIENCIAS MEDICAS | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | CENTRO DE ENFERMEDADES INFLAMATORIAS DEL INTESTINO CEM | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 29134 | ||||||||
Address2: | CENTRO DE ENFERMEDADES INFLAMATORIAS | ||||||||
City: | SAN JUAN | ||||||||
State: | PR | ||||||||
PostalCode: | 009290134 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7877587910 | ||||||||
FaxNumber: | 7876251966 | ||||||||
Practice Location | |||||||||
Address1: | REPARTO METROPOLITANO SHOPPING, AVE. AMERICO MIRANDA | ||||||||
Address2: | CLINICA DE LA ESCUELA DE MEDICINA | ||||||||
City: | RIO PIEDRAS | ||||||||
State: | PR | ||||||||
PostalCode: | 00921 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7877587910 | ||||||||
FaxNumber: | 7876251966 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/23/2014 | ||||||||
LastUpdateDate: | 12/23/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MORALES | ||||||||
AuthorizedOfficialFirstName: | SHAYRA | ||||||||
AuthorizedOfficialMiddleName: | C. | ||||||||
AuthorizedOfficialTitleorPosition: | ADMINISTRATIVE SECRETARY | ||||||||
AuthorizedOfficialTelephone: | 7877549165 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |   | 133N00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Dietary & Nutritional Service Providers | Nutritionist |   | 183500000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Pharmacy Service Providers | Pharmacist |   | 207R00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RG0100X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 2084P0800X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 208600000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |   | 261QM1300X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.