MEDICARE: FAMILY OB-GYN GROUP PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	6403	PR

General Provider Information

NPI Number	:	1588094189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY OB-GYN GROUP PSC

Provider Business Mailing Address
First Line	:	138 AVE WINSTON CHURCHILL
Second Line	:	PMB 315
City	:	SAN JUAN
State	:	PR
Zip	:	00926-6023
Country	:	US
Telephone Number	:	787-758-1910
Fax Number	:	787-751-4812

Provider Business Practice Location Address
First Line	:	RIO PIEDRAS HEIGHTS MALL
Second Line	:	1729 SEGRE
City	:	SAN JUAN
State	:	PR
Zip	:	00926-3181
Country	:	US
Telephone Number	:	787-758-1910
Fax Number	:	787-751-4812

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CARLOS J MARRERO ARROYO
Credential	:	M.D.
Telephone Number	:	787-568-1225

Provider Enumeration Date	:	11/18/2013
Last Update Date	:	02/06/2014

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