MEDICARE: OBGYN MEDICAL LLC

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

General Provider Information

NPI Number	:	1659855617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OBGYN MEDICAL LLC

Provider Business Mailing Address
First Line	:	1565 CALLE ALDA
Second Line	:	URB CARIBE
City	:	SAN JUAN
State	:	PR
Zip	:	00926
Country	:	US
Telephone Number	:	787-667-9729
Fax Number	:

Provider Business Practice Location Address
First Line	:	1565 CALLE ALDA
Second Line	:	URB CARIBE
City	:	SAN JUAN
State	:	PR
Zip	:	00926
Country	:	US
Telephone Number	:	787-667-9729
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	OLGA M PEREIRA
Credential	:	MD
Telephone Number	:	787-667-9729

Provider Enumeration Date	:	09/17/2018
Last Update Date	:	10/02/2018

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