Basic Information
| Provider Information | |||||||||
| NPI: | 1578772042 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATES OF CARIBBEAN ADVANCED OB-GYN GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 742 | ||||||||
| Address2: | |||||||||
| City: | ARECIBO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006130742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878781911 | ||||||||
| FaxNumber: | 7878781911 | ||||||||
| Practice Location | |||||||||
| Address1: | CARRETERA 129 | ||||||||
| Address2: | HOSPITAL DR. CAYETANO COLL Y TOSTE | ||||||||
| City: | ARECIBO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876507272 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | RODRIGUEZ GOMEZ | ||||||||
| AuthorizedOfficialFirstName: | JOSE | ||||||||
| AuthorizedOfficialMiddleName: | MANUEL | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7878781911 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 83902CA | 01 | PR | TRIPLE S, INC PROVIDER NO | OTHER |