Provider Demographics
NPI: | 1710275144 |
---|---|
Name: | RECINTO DE CIENCIAS MEDICAS |
Entity Type: | Organization |
Organization Name: | RECINTO DE CIENCIAS MEDICAS |
Other - Org Name: | RECINTO DE CIENCIAS MEDICAS (CENTRO ENFERMEDADES HEREDITARIAS DE PR) |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | ADM. SECRETARY |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SHAYRA |
Authorized Official - Middle Name: | C |
Authorized Official - Last Name: | MORALES |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 787-754-9165 |
Mailing Address - Street 1: | PO BOX 29134 |
Mailing Address - Street 2: | CENTRO DE ENFERMEDADES HEREDITARIAS DE PR |
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: | OFIC. 563 EDIF. PRINCIPAL RCM |
Practice Address - Street 2: | CENTRO MEDICO DE PUERTO RICO |
Practice Address - City: | RIO PIEDRAS |
Practice Address - State: | PR |
Practice Address - Zip Code: | 00935-0000 |
Practice Address - Country: | US |
Practice Address - Phone: | 787-754-9165 |
Practice Address - Fax: | 787-274-8156 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-07-19 |
Last Update Date: | 2011-07-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PR | 104100000X, 133VN1004X, 133VN1006X, 163W00000X, 163WP0200X, 164W00000X, 207SC0300X, 207SG0201X, 207SG0202X, 207SG0203X, 2080P0201X, 2080P0214X, 291U00000X | |
170300000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207SG0201X | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Genetics (M.D.) | Group - Multi-Specialty |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
No | 133VN1004X | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Pediatric | Group - Multi-Specialty |
No | 133VN1006X | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Metabolic | Group - Multi-Specialty |
No | 163W00000X | Nursing Service Providers | Registered Nurse | Group - Multi-Specialty | |
No | 163WP0200X | Nursing Service Providers | Registered Nurse | Pediatrics | Group - Multi-Specialty |
No | 164W00000X | Nursing Service Providers | Licensed Practical Nurse | Group - Multi-Specialty | |
No | 170300000X | Other Service Providers | Genetic Counselor, MS | Group - Multi-Specialty | |
No | 207SC0300X | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Cytogenetics | Group - Multi-Specialty |
No | 207SG0202X | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Biochemical Genetics | Group - Multi-Specialty |
No | 207SG0203X | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Molecular Genetics | Group - Multi-Specialty |
No | 2080P0201X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Allergy/Immunology | Group - Multi-Specialty |
No | 2080P0214X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology | Group - Multi-Specialty |
No | 291U00000X | Laboratories | Clinical Medical Laboratory | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PR | 001 | Other | PPMI GROUP |