Provider Demographics
NPI:1225542426
Name:INSTITUTO GINECOLOGICO DEL OESTE CRL
Entity Type:Organization
Organization Name:INSTITUTO GINECOLOGICO DEL OESTE CRL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-868-6474
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0128
Mailing Address - Country:US
Mailing Address - Phone:787-868-6474
Mailing Address - Fax:787-868-6474
Practice Address - Street 1:CARR 2 KM 129.3
Practice Address - Street 2:BARRIO VICTORIA
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-868-6474
Practice Address - Fax:787-868-6474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8531207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty