Provider Demographics
NPI:1225112691
Name:CENTRO DE CUIDADO GINECO OBSTETRICO
Entity Type:Organization
Organization Name:CENTRO DE CUIDADO GINECO OBSTETRICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:N
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:787-753-7557
Mailing Address - Street 1:PO BOX 195472
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-5472
Mailing Address - Country:US
Mailing Address - Phone:787-753-7557
Mailing Address - Fax:787-753-7592
Practice Address - Street 1:239 AVE ARTERIAL HOSTOS
Practice Address - Street 2:SUITE205 CAPITAL CENTER BUILDING
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-1474
Practice Address - Country:US
Practice Address - Phone:787-753-7557
Practice Address - Fax:787-753-7592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR26115OtherTRIPLE S
PR26115OtherTRIPLE S