Provider Demographics
NPI:1255478103
Name:RECINTO DE CIENCIAS MEDICAS
Entity Type:Organization
Organization Name:RECINTO DE CIENCIAS MEDICAS
Other - Org Name:RECINTO DE CIENCIAS MEDICAS (ABERGUE OLIMPICO RCM)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:RHIA
Authorized Official - Phone:787-758-2525
Mailing Address - Street 1:ALBERGUE OLIMPICO RCM
Mailing Address - Street 2:PO BOX 29134
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0134
Mailing Address - Country:US
Mailing Address - Phone:787-758-2525
Mailing Address - Fax:787-274-8156
Practice Address - Street 1:AVE. AMERICO MIRANDA APTDO. 29134 CENTRO MEDICO DE PR
Practice Address - Street 2:EDIF. PRINCIPAL ESCUELA DE MEDICINA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00929-0134
Practice Address - Country:US
Practice Address - Phone:787-758-2525
Practice Address - Fax:787-274-8156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR95OtherPPMI GROUP
PR82449Medicare PIN