Provider Demographics
NPI:1629115183
Name:GRUPO OBSTETRICO GINECOLOGICO DE MAYAGUEZ
Entity Type:Organization
Organization Name:GRUPO OBSTETRICO GINECOLOGICO DE MAYAGUEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELICA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-833-0348
Mailing Address - Street 1:PO BOX 1496
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1496
Mailing Address - Country:US
Mailing Address - Phone:787-833-0348
Mailing Address - Fax:787-805-0710
Practice Address - Street 1:PERAL ESQ DE DIEGO EDIF LA PALMA
Practice Address - Street 2:SUITE 2 A
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-833-0348
Practice Address - Fax:787-805-0710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty