Healthcare Provider Details

I. General information

NPI: 1013013465
Provider Name (Legal Business Name): GRUPO GINECO-OBSTETRICO DEL NORTE PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 CALLE GEORGETTI
SAN JUAN PR
00925
US

IV. Provider business mailing address

66 CALLE GEORGETTI
SAN JUAN PR
00925
US

V. Phone/Fax

Practice location:
  • Phone: 787-765-4208
  • Fax:
Mailing address:
  • Phone: 787-765-4208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GISELLE M TRILLO
Title or Position: BILLING/ADMINISTRATOR
Credential:
Phone: 787-413-4896