Provider Demographics
NPI:1578010187
Name:INNOVATIVE GYN P.S.C.
Entity Type:Organization
Organization Name:INNOVATIVE GYN P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIANETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-258-0614
Mailing Address - Street 1:500 AVE DEGETAU
Mailing Address - Street 2:HIMA PLAZA ONE STE 414
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-258-0614
Mailing Address - Fax:787-961-4663
Practice Address - Street 1:500 AVE DEGETAU STE 414
Practice Address - Street 2:500 AVE DEGETAU
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-7307
Practice Address - Country:US
Practice Address - Phone:787-258-0614
Practice Address - Fax:787-961-4663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty