Healthcare Provider Details

I. General information

NPI: 1568565547
Provider Name (Legal Business Name): RECINTO DE CIENCIAS MEDICAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 02/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE.AMERICO MIRANDA CENTRO MEDICO DE PR EDIF. PRINCIPAL ESCUELA DE MEDICINA APTDO.29134
SAN JUAN PR
00936-0134
US

IV. Provider business mailing address

PO BOX 29134
SAN JUAN PR
00929-0134
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2525
  • Fax: 787-274-8154
Mailing address:
  • Phone: 787-758-2525
  • Fax: 787-274-8154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MYRIAM TROCHE
Title or Position: CREDENTIALING COORDINATOR
Credential: RHIA
Phone: 787-758-2525