=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285738583
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RECINTO DE CIENCIAS MEDICAS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2006
-----------------------------------------------------
Last Update Date | 09/22/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | AVE.AMERICO MIRANDA CENTRO MEDICO DE PR EDIF. PRINCIPAL ESVUELA DE MEDICINA APTDO.29134
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00929-0134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-758-2525
-----------------------------------------------------
Fax | 787-274-8154
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | MEDICINA INTERNA RCM PO BOX 29134
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00929-0134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-758-2525
-----------------------------------------------------
Fax | 787-274-8154
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING COORDINATOR
-----------------------------------------------------
Name | MRS. MYRIAM TROCHE
-----------------------------------------------------
Credential | RHIA
-----------------------------------------------------
Telephone | 787-758-2525
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------