Provider Demographics
NPI:1740688696
Name:TEAM OB-GYN, PSC
Entity type:Organization
Organization Name:TEAM OB-GYN, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-854-3249
Mailing Address - Street 1:PO BOX 1020
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1020
Mailing Address - Country:US
Mailing Address - Phone:787-854-3249
Mailing Address - Fax:787-854-2613
Practice Address - Street 1:1 CALLE HERNANDEZ CARRION
Practice Address - Street 2:HOSPITAL MANATI MEDICAL CENTER STE 206
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-3249
Practice Address - Fax:787-854-2613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR88539Medicare PIN