Provider Demographics
NPI:1558425314
Name:RECINTO DE CIENCIAS MEDICAS
Entity Type:Organization
Organization Name:RECINTO DE CIENCIAS MEDICAS
Other - Org Name:NEFROLOGIA
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING OFFICER
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 29207
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0207
Mailing Address - Country:US
Mailing Address - Phone:787-757-6330
Mailing Address - Fax:787-757-0520
Practice Address - Street 1:AVE. 65 DE INFANTERIA
Practice Address - Street 2:CARR. #3 KM. 8.3
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00984
Practice Address - Country:US
Practice Address - Phone:787-757-6330
Practice Address - Fax:787-757-0520
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RECINTO DE CIENCIAS MEDICAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-19
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherUPR NEFROLOGIA HAC