Healthcare Provider Details

I. General information

NPI: 1093857583
Provider Name (Legal Business Name): RECINTO DE CIENCIAS MEDICAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. 65 DE INFANTERIA APTDO. 29207
CAROLINA PR
00929-0207
US

IV. Provider business mailing address

PO BOX 29207
SAN JUAN PR
00929-0207
US

V. Phone/Fax

Practice location:
  • Phone: 787-757-6330
  • Fax: 787-757-0520
Mailing address:
  • Phone: 787-757-6330
  • Fax: 787-757-0520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MYRIAM TROCHE
Title or Position: CREDENTIALING COORDINATOR
Credential: RHIA
Phone: 787-757-6330