Provider Demographics
NPI:1205813748
Name:CIRUJANOS UNIDOS DEL NOROESTE
Entity Type:Organization
Organization Name:CIRUJANOS UNIDOS DEL NOROESTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCELO
Authorized Official - Middle Name:J
Authorized Official - Last Name:OBEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-891-8090
Mailing Address - Street 1:25 AVE SEVERIANO CUEVAS
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-5713
Mailing Address - Country:US
Mailing Address - Phone:787-891-8090
Mailing Address - Fax:787-891-8190
Practice Address - Street 1:25 AVE SEVERIANO CUEVAS
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5713
Practice Address - Country:US
Practice Address - Phone:787-891-8090
Practice Address - Fax:787-891-8190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6204208600000X
PR4943208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D26648Medicare UPIN
C79538Medicare UPIN
PR28309Medicare ID - Type Unspecified