Healthcare Provider Details

I. General information

NPI: 1730637471
Provider Name (Legal Business Name): CARIBBEAN WOMENS HEALTH INSTITUTE CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PR 505 KM 1.0 URB GLENVIEW GARDENS GLENVIEW GARDENS SHOPPING CENTER LOCAL #4
PONCE PR
00731
US

IV. Provider business mailing address

PO BOX 102
MERCEDITA PR
00715
US

V. Phone/Fax

Practice location:
  • Phone: 787-812-3153
  • Fax: 787-844-3003
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number19375
License Number StatePR

VIII. Authorized Official

Name: LISANDRA CORDERO NIEVES
Title or Position: MD
Credential:
Phone: 787-812-3153