Basic Information
| Provider Information | |||||||||
| NPI: | 1518505163 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RECINTO DE CIENCIAS MEDICAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | MEDICINA DE EMERGENCIA PEDIATRICA RCM | ||||||||
| Address2: | PO BOX 29134 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009290134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877564010 | ||||||||
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| Practice Location | |||||||||
| Address1: | SALA DE EMERGENCIA HOSPITAL PEDIATRICO UNIVERSITARIO | ||||||||
| Address2: | CENTRO MEDICO DE PUERTO RICO, BO. MONACILLOS | ||||||||
| City: | RIO PIEDRAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874740333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2019 | ||||||||
| LastUpdateDate: | 12/13/2019 | ||||||||
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| AuthorizedOfficialLastName: | MORALES | ||||||||
| AuthorizedOfficialFirstName: | SHAYRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 7877582525 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | BA | ||||||||
| NPICertificationDate: | 12/13/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PP0204X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Pediatric Emergency Medicine | 208000000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0204X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Emergency Medicine |
No ID Information.