1205868676 NPI number — RECINTO DE CIENCIAS MEDICAS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205868676 NPI number — RECINTO DE CIENCIAS MEDICAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RECINTO DE CIENCIAS MEDICAS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RECINTO DE CIENCIAS MEDICAS-CIRUGIA ORAL Y MAXILOFACIAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205868676
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 29134
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00929-0134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-758-2525
Provider Business Mailing Address Fax Number:
787-274-8154

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CENTRO MEDICO DE PR EDIF. PRINCIPAL
Provider Second Line Business Practice Location Address:
ESCUELA DE MEDICINA APTO 29134
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00936-0134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-758-2525
Provider Business Practice Location Address Fax Number:
787-274-8156
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TROCHE
Authorized Official First Name:
MYRIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING COORDINATOR
Authorized Official Telephone Number:
787-758-2525

Provider Taxonomy Codes

  • Taxonomy code: 204E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9 . This is a "PPMI GROUP" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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