Healthcare Provider Details

I. General information

NPI: 1124235387
Provider Name (Legal Business Name): GRUPO OBSTETRICO INTEGRADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE PONCE DE LEON PARADA 37.5
HATO REY PR
00919
US

IV. Provider business mailing address

PO BOX 193467
SAN JUAN PR
00919-3467
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2000
  • Fax:
Mailing address:
  • Phone: 787-756-0100
  • Fax: 787-756-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE V SOMOHANO
Title or Position: OB GYN
Credential:
Phone: 787-756-0100