Basic Information
Provider Information | |||||||||
NPI: | 1629559323 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | HERA GINECOLOGIA Y OBSTETRICIA | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 252 SAN JORGE MEDICAL BUILDING | ||||||||
Address2: | SUITE 405 | ||||||||
City: | SANTURCE | ||||||||
State: | PR | ||||||||
PostalCode: | 00912 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7877271000 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 252 SAN JORGE MEDICAL BUILDING | ||||||||
Address2: | SUITE 405 | ||||||||
City: | SANTURCE | ||||||||
State: | PR | ||||||||
PostalCode: | 00912 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7877271000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/22/2018 | ||||||||
LastUpdateDate: | 05/31/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | LLINAS MESSEGUER | ||||||||
AuthorizedOfficialFirstName: | MARIOLA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CORPORATION PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 7874082678 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: | 05/31/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X |   | PR | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
No ID Information.