Healthcare Provider Details

I. General information

NPI: 1558182121
Provider Name (Legal Business Name): WOMEN'S PELVIC HEALTH AND RECONSTRUCTIVE SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 AVE PONCE DE LEON
SAN JUAN PR
00917-5022
US

IV. Provider business mailing address

735 AVE PONCE DE LEON
SAN JUAN PR
00917-5022
US

V. Phone/Fax

Practice location:
  • Phone: 787-685-8082
  • Fax:
Mailing address:
  • Phone: 787-685-8082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DARLENE VARGAS MALDONADO
Title or Position: UROGYNECOLOGY
Credential: MD
Phone: 787-685-8082