Provider Demographics
NPI:1316022312
Name:RECINTO DE CIENCIAS MEDICAS
Entity Type:Organization
Organization Name:RECINTO DE CIENCIAS MEDICAS
Other - Org Name:RECINTO DE CIENCIAS MEDICAS (NEUROCIRUGIA ENDOVASCULAR 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:PO BOX 29134
Mailing Address - Street 2:NEUROCIRUGIA ENDOVASCULAR RCM
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0134
Mailing Address - Country:US
Mailing Address - Phone:787-754-0101
Mailing Address - Fax:787-274-8156
Practice Address - Street 1:CENTRO MEDICO DE PR EDIF PRINCIPAL RCM OFIC 563
Practice Address - Street 2:ESCUELA DE MEDICINA PPMI APTDO. 29134
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:2006-10-26
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Single Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR12OtherPPMI GROUP
PREH821AMedicare UPIN
PR89032AMedicare PIN