Provider Demographics
NPI:1093861643
Name:CONS MEDICO GINECOLOGIA Y OBSTETRICIA
Entity Type:Organization
Organization Name:CONS MEDICO GINECOLOGIA Y OBSTETRICIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZULMA
Authorized Official - Middle Name:IRIS
Authorized Official - Last Name:JURADO AGOSTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1787-256-0132
Mailing Address - Street 1:PO BOX 10000
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-0011
Mailing Address - Country:US
Mailing Address - Phone:787-256-0132
Mailing Address - Fax:
Practice Address - Street 1:CALLE PALMER #18 ESQ. BLANCO SOSA
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-0011
Practice Address - Country:US
Practice Address - Phone:787-256-0132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11620174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR87649Medicare ID - Type Unspecified