Basic Information
| Provider Information | |||||||||
| NPI: | 1689752461 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RECINTO DE CIENCIAS MEDICAS | ||||||||
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| OtherOrganizationName: | RECINTO DE CIENCIAS MEDICAS (OBSTETRICIA Y GINECOLOGIA RCM) | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | OBSTETRICIA Y GINECOLOGIA RCM | ||||||||
| Address2: | PO BOX 29134 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009290134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877582525 | ||||||||
| FaxNumber: | 7872748156 | ||||||||
| Practice Location | |||||||||
| Address1: | CENTRO COMERCIAL REPARTO METROPOLITANO SUITE 211 | ||||||||
| Address2: | AVE. AMERICO MIRANDA | ||||||||
| City: | RIO PIEDRAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877587910 | ||||||||
| FaxNumber: | 7872748156 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 11/21/2011 | ||||||||
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| AuthorizedOfficialLastName: | TROCHE | ||||||||
| AuthorizedOfficialFirstName: | MYRIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 7877549165 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | RHIA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | 207VM0101X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | 207VX0201X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology | 207V00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | ----29 | 01 | PPMI GROUP | OTHER |