Provider Demographics
NPI:1063865822
Name:RECINTO DE CIENCIAS MEDICAS
Entity Type:Organization
Organization Name:RECINTO DE CIENCIAS MEDICAS
Other - Org Name:RECINTO DE CIENCIAS MEDICAS (OB URO GYN FPMRS RCM)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:787-754-9165
Mailing Address - Street 1:PO BOX 29134
Mailing Address - Street 2:URO GYN FPMRS RCM
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0134
Mailing Address - Country:US
Mailing Address - Phone:787-765-9652
Mailing Address - Fax:787-764-7881
Practice Address - Street 1:1160 AVE AMERICO MIRANDA REPARTO METROPOLITANO SHOPPING
Practice Address - Street 2:CLINICA DE LA ESCUELA DE MEDICINA
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00921-2213
Practice Address - Country:US
Practice Address - Phone:787-620-4012
Practice Address - Fax:787-522-3325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR207VF0040X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Single Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty