Provider Demographics
NPI:1447418173
Name:RECINTO DE CIENCIAS MEDICAS
Entity Type:Organization
Organization Name:RECINTO DE CIENCIAS MEDICAS
Other - Org Name:PPMI CLINICA DE LA ESCUELA DE MEDICINA
Other - Org Type:Other Name
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:787-754-9165
Mailing Address - Street 1:PO BOX 29134
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0134
Mailing Address - Country:US
Mailing Address - Phone:787-754-9165
Mailing Address - Fax:787-274-8156
Practice Address - Street 1:AVE. AMERICO MIRANDA
Practice Address - Street 2:REPARTO METROPOLITANO SHOPPING CENTER
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-758-7910
Practice Address - Fax:787-281-6097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR251300000X, 261QH0100X, 261QM1300X, 261QM2500X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No251300000XAgenciesLocal Education Agency (LEA)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherTAX ID. NUMBER