Provider Demographics
NPI:1396950283
Name:PRIMARY CARE & OB GYN
Entity type:Organization
Organization Name:PRIMARY CARE & OB GYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:FLORES CABAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-753-1777
Mailing Address - Street 1:735 AVE PONCE DE LEON
Mailing Address - Street 2:SUITE 710
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-5022
Mailing Address - Country:US
Mailing Address - Phone:787-753-1777
Mailing Address - Fax:787-753-1820
Practice Address - Street 1:735 AVE PONCE DE LEON
Practice Address - Street 2:SUITE 710
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5022
Practice Address - Country:US
Practice Address - Phone:787-753-1777
Practice Address - Fax:787-753-1820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13060207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH82242Medicare UPIN