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General NPI Number Information
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NPI Number | 1336210038
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Entity Type | Organization
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Legal Business Name | SAN JUAN PELVIC MEDICINE CENTER, P.S.C.
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 03/13/2008
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Provider Practice Location Address
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Address Line | 400 AVE DOMENECH SUITE 205
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City | SAN JUAN
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State | PR
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Zip | 00918-3710
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Country | US
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Telephone | 787-753-7174
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Fax | 787-758-6116
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Provider Business Mailing Address
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Address Line | 400 AVE DOMENECH SUITE 205
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City | SAN JUAN
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State | PR
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Zip | 00918-3710
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Country | US
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Telephone | 787-753-7174
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Fax | 787-758-6116
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Authorized Official
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Title or Position | PRESIDENT
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Name | OSCAR OSORIO
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Credential | M.D.
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Telephone | 787-753-7174
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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 | 13296
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License Number State | PR
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