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
StateLicense IDTaxonomies
PR104100000X, 133VN1004X, 133VN1006X, 163W00000X, 163WP0200X, 164W00000X, 207SC0300X, 207SG0201X, 207SG0202X, 207SG0203X, 2080P0201X, 2080P0214X, 291U00000X
170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)Group - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Multi-Specialty
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WP0200XNursing Service ProvidersRegistered NursePediatricsGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No170300000XOther Service ProvidersGenetic Counselor, MSGroup - Multi-Specialty
No207SC0300XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical CytogeneticsGroup - Multi-Specialty
No207SG0202XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Biochemical GeneticsGroup - Multi-Specialty
No207SG0203XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Molecular GeneticsGroup - Multi-Specialty
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/ImmunologyGroup - Multi-Specialty
No2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR001OtherPPMI GROUP