Provider Demographics
NPI:1033265129
Name:MATERNIDAD Y CLINICA GINECOLOGICA
Entity Type:Organization
Organization Name:MATERNIDAD Y CLINICA GINECOLOGICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRILLA
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:787-381-4652
Mailing Address - Street 1:EDIFICIO MEDICO SANTA CRUZ SUITE 311
Mailing Address - Street 2:COLLE STA CRUZ #73
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-798-3835
Mailing Address - Fax:787-798-4230
Practice Address - Street 1:EDIF MEDICO SANTA CRUZ
Practice Address - Street 2:SUITE 311
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6910
Practice Address - Country:US
Practice Address - Phone:787-798-3835
Practice Address - Fax:787-798-4230
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MATERNIDAD Y CLINICA GINECOLOGICA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-25
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207V00000X
PR5325207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR28362MAOtherTRIPLE SSS
PR068618OtherCRUZ AZUL
PR25025OtherMCS
PRN687OtherIMC
PR28362MAOtherTRIPLE SSS