Basic Information
Provider Information
NPI: 1548691579
EntityType: 2
ReplacementNPI:  
OrganizationName: RECINTO DE CIENCIAS MEDICAS
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: RECINTO DE CIENCIAS MEDICAS (GENETIC CANCER CLINIC)
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 29134
Address2:  
City: SAN JUAN
State: PR
PostalCode: 009290134
CountryCode: US
TelephoneNumber: 7877587910
FaxNumber:  
Practice Location
Address1: AVENIDA AMERICO MIRANDA CENTRO COMERCIAL
Address2: REPARTO METROPOLITANO
City: RIO PIEDRAS
State: PR
PostalCode: 009290134
CountryCode: US
TelephoneNumber: 7877587910
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/02/2013
LastUpdateDate: 12/02/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: RAMOS
AuthorizedOfficialFirstName: DIANA
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: ADMINISTRATIVE ASISTANT
AuthorizedOfficialTelephone: 7877549165
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MRS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QX0200X  Y Ambulatory Health Care FacilitiesClinic/CenterOncology

No ID Information.


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