1528710241 NPI number — PEDIATRIC GYNECOLOGY OF PUERTO RICO LLC

Table of content: (NPI 1528710241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528710241 NPI number — PEDIATRIC GYNECOLOGY OF PUERTO RICO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC GYNECOLOGY OF PUERTO RICO LLC
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:
Provider Other Organization Name Type Code:
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:
1528710241
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3303 CALLE DONA JUANA
Provider Second Line Business Mailing Address:
EL MONTE
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-405-6168
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
253 SAN JORGE
Provider Second Line Business Practice Location Address:
SAN JORGE BUILDING SUITE 403
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-478-7334
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/24/2022

Additional Information

Authorized Official

Authorized Official Last Name:
OQUENDO DEL TORO
Authorized Official First Name:
HELEN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-405-6168

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VG0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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