MEDICARE: ELITE OB-GYN

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	261QM2500X	Medical Specialty Clinic/Center	18371	PR

General Provider Information

NPI Number	:	1619421096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE OB-GYN

Provider Business Mailing Address
First Line	:	C13 CALLE B
Second Line	:	EL DORADO
City	:	SAN JUAN
State	:	PR
Zip	:	00926-3405
Country	:	US
Telephone Number	:	787-237-8428
Fax Number	:	787-946-7676

Provider Business Practice Location Address
First Line	:	1565 CALLE ALDA
Second Line	:	URB CARIBE
City	:	SAN JUAN
State	:	PR
Zip	:	00926-2712
Country	:	US
Telephone Number	:	787-930-3410
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CRISTINA A ABREU
Credential	:	MD
Telephone Number	:	787-930-3410

Provider Enumeration Date	:	08/15/2016
Last Update Date	:	08/15/2016

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