Provider Demographics
| NPI: | 1952627648 |
|---|---|
| Name: | RECINTO DE CIENCIAS MEDICAS |
| Entity Type: | Organization |
| Organization Name: | RECINTO DE CIENCIAS MEDICAS |
| Other - Org Name: | PLAN DE PRACTICA MEDICA INTRAMURAL |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | CREDENTIALING COORDINATOR |
| 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: | 787-754-9165 |
| Mailing Address - Street 1: | PO BOX 29134 |
| Mailing Address - Street 2: | |
| 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: | EDIF. PRINCIPAL RCM - 5TO PISO OFIC. 563 ESC. MEDICINA |
| Practice Address - Street 2: | CENTRO MEDICO DE PUERTO RICO, BO MONACILLOS |
| Practice Address - City: | SAN JUAN |
| Practice Address - State: | PR |
| Practice Address - Zip Code: | 00935 |
| 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: | 2010-04-20 |
| Last Update Date: | 2012-07-19 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Single Specialty | |
| No | 204E00000X | Allopathic & Osteopathic Physicians | Oral & Maxillofacial Surgery | Group - Single Specialty | |
| No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Single Specialty | |
| No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Single Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Single Specialty | |
| No | 207U00000X | Allopathic & Osteopathic Physicians | Nuclear Medicine | Group - Single Specialty | |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Single Specialty | |
| No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Single Specialty | |
| No | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | Group - Single Specialty |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Single Specialty | |
| No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Single Specialty | |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Single Specialty |
| No | 2085B0100X | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | Group - Single Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Single Specialty | |
| No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Single Specialty |
