=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538634894
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GUAYNABO GYNECOLOGICAL CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2018
-----------------------------------------------------
Last Update Date | 10/12/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CAPARRA GALLERY PLAZA SUITE 312 107 CALLE ORTEGON
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00966
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-754-0907
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 30763
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00929-1763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-754-0907
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ALEXANDRA ALVIRA - LOPEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 787-754-0907
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------