Provider Demographics
NPI:1841531316
Name:SALISH OBGYN SERVICES CSP
Entity type:Organization
Organization Name:SALISH OBGYN SERVICES CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ORTIZ SANCHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-788-0080
Mailing Address - Street 1:1231 CALLE CARDENAS
Mailing Address - Street 2:PURTO NUEVO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-5148
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:77 CALLE LAS FLORES
Practice Address - Street 2:
Practice Address - City:CATANO
Practice Address - State:PR
Practice Address - Zip Code:00962-4701
Practice Address - Country:US
Practice Address - Phone:787-788-0080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7114174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE30431Medicare UPIN