Healthcare Provider Details

I. General information

NPI: 1003291097
Provider Name (Legal Business Name): GYNE-OB MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BC20 CALLE AMAZONAS VALLE VERDE
BAYAMON PR
00961-3271
US

IV. Provider business mailing address

BC20 CALLE AMAZONAS VALLE VERDE
BAYAMON PR
00961-3271
US

V. Phone/Fax

Practice location:
  • Phone: 787-461-5677
  • Fax:
Mailing address:
  • Phone: 787-461-5677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NW0100X
TaxonomyWomen's Hospital
License Number18199
License Number StatePR

VIII. Authorized Official

Name: DR. YURIZAM RAMIREZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-461-5677