Provider Demographics
NPI:1013013465
Name:GRUPO GINECO-OBSTETRICO DEL NORTE PSC
Entity Type:Organization
Organization Name:GRUPO GINECO-OBSTETRICO DEL NORTE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GISELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-413-4896
Mailing Address - Street 1:66 CALLE GEORGETTI
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00925
Mailing Address - Country:US
Mailing Address - Phone:787-765-4208
Mailing Address - Fax:
Practice Address - Street 1:66 CALLE GEORGETTI
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925
Practice Address - Country:US
Practice Address - Phone:787-765-4208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR28009OtherSSS
PR28009Medicare ID - Type Unspecified