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General NPI Number Information
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NPI Number | 1063891927
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Entity Type | Organization
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Legal Business Name | CENTRO OBSTETRICIA Y GINECOLOGIA
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Dates
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Enumeration Date | 05/26/2015
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Last Update Date | 05/26/2015
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Provider Practice Location Address
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Address Line | 195 CALLE GAUTIER BENITEZ
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City | CAGUAS
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State | PR
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Zip | 00725-5509
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Country | US
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Telephone | 787-703-5353
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Fax | 787-957-7052
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Provider Business Mailing Address
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Address Line | PO BOX 785
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City | SAN LORENZO
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State | PR
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Zip | 00754-0785
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Country | US
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Telephone | 787-703-5353
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Fax | 787-957-7052
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PEDRO ANGEL DIAZ BRETANA
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Credential | M.D.
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Telephone | 787-703-5353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 12787
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License Number State | PR
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