Healthcare Provider Details

I. General information

NPI: 1285928770
Provider Name (Legal Business Name): MOGIC OB-GYN PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MMC PROFESSIONAL PLAZA SUITES 206 & 207
MANATI PR
00674
US

IV. Provider business mailing address

PO BOX 1087
MANATI PR
00674-1087
US

V. Phone/Fax

Practice location:
  • Phone: 787-621-4949
  • Fax:
Mailing address:
  • Phone: 787-452-2410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. AXEL TORRES
Title or Position: MD
Credential: M.D.
Phone: 787-452-2410