Basic Information
| Provider Information | |||||||||
| NPI: | 1649607854 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RECINTO DE CIENCIAS MEDICAS | ||||||||
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| OtherOrganizationName: | CLINICA CIRUGIA ORAL Y MAXILOFACIAL RCM | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | CIRUGIA ORAL Y MAXILOFACIAL | ||||||||
| Address2: | PO BOX 29134 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009290134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877582525 | ||||||||
| FaxNumber: | 7877510808 | ||||||||
| Practice Location | |||||||||
| Address1: | ESCUELA DE MEDICINA DENTAL RCM PISO 1 OFIC 128 | ||||||||
| Address2: | CENTRO MEDICO DE PUERTO RICO, BO. MONACILLOS | ||||||||
| City: | RIO PIEDRAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009290134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877582525 | ||||||||
| FaxNumber: | 7877510858 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2013 | ||||||||
| LastUpdateDate: | 10/02/2013 | ||||||||
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| AuthorizedOfficialLastName: | CONCEPCION | ||||||||
| AuthorizedOfficialFirstName: | ISHBELL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADM. ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 7877582525 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS0112X | PR | Y | Ambulatory Health Care Facilities | Clinic/Center | Oral and Maxillofacial Surgery |
No ID Information.