Healthcare Provider Details

I. General information

NPI: 1972766210
Provider Name (Legal Business Name): INSTITUTO GINECO-OBSTETRICO DE BARCELONETA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CALLE TOMAS DAVILA
BARCELONETA PR
00617-2798
US

IV. Provider business mailing address

PO BOX 146
BARCELONETA PR
00617-0146
US

V. Phone/Fax

Practice location:
  • Phone: 787-623-8232
  • Fax: 787-623-3847
Mailing address:
  • Phone: 787-623-8232
  • Fax: 787-623-3847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number15542
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JOEL RIVERA JIMENEZ
Title or Position: PRESIDENT
Credential: M.D
Phone: 787-623-8232