Basic Information
| Provider Information | |||||||||
| NPI: | 1447418173 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RECINTO DE CIENCIAS MEDICAS | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | PPMI CLINICA DE LA ESCUELA DE MEDICINA | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 29134 | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009290134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877549165 | ||||||||
| FaxNumber: | 7872748156 | ||||||||
| Practice Location | |||||||||
| Address1: | AVE. AMERICO MIRANDA | ||||||||
| Address2: | REPARTO METROPOLITANO SHOPPING CENTER | ||||||||
| City: | RIO PIEDRAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877587910 | ||||||||
| FaxNumber: | 7872816097 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2008 | ||||||||
| LastUpdateDate: | 08/03/2015 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TROCHE | ||||||||
| AuthorizedOfficialFirstName: | MYRIAM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 7877549165 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | RHIA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251300000X | PR | N | Agencies | Local Education Agency (LEA) | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 261QH0100X | PR | N | Ambulatory Health Care Facilities | Clinic/Center | Health Service | 261QM2500X | PR | N | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty | 261QM1300X | PR | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.