Healthcare Provider Details

I. General information

NPI: 1619422581
Provider Name (Legal Business Name): NSM OB-GYN MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 AVENIDA PONCE DE LEON SUITE 205
SAN JUAN PUERTO RICO
00909
UM

IV. Provider business mailing address

PO BOX 1765
DORADO PR
00646-1765
US

V. Phone/Fax

Practice location:
  • Phone: 787-201-6246
  • Fax:
Mailing address:
  • Phone: 787-594-3204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NITZA MERCEDES SERRANO-MEDINA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-594-3204