Healthcare Provider Details

I. General information

NPI: 1376698613
Provider Name (Legal Business Name): RECINTO DE CIENCIAS MEDICAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 10/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO MEDICO DE PR EDIF. PRINCIPAL ESCUELA DE MEDICINA APTDO.29134
SAN JUAN PR
00929-0134
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: 787-274-8156
Mailing address:
  • Phone: 787-758-2525
  • Fax: 787-274-8158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

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