Healthcare Provider Details
I. General information
NPI: 1942812904
Provider Name (Legal Business Name): CENTRO DE BIENESTAR PARA LA MUJER LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/20/2020
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:
III. Provider practice location address
CAPARRA GALLERY 107, ORTEGON AVE. SUITE 312
GUAYNABO PR
00969
US
IV. Provider business mailing address
PO BOX 366492
SAN JUAN PR
00936-6492
US
V. Phone/Fax
- Phone: 787-754-0907
- Fax:
- Phone: 787-754-0907
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207V00000X |
| Taxonomy | Obstetrics & Gynecology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
PAMELA
SILEN RIVERA
Title or Position: CEO
Credential: MD FACOG
Phone: 787-242-6033