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General NPI Number Information
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NPI Number | 1578010187
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Entity Type | Organization
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Legal Business Name | INNOVATIVE GYN P.S.C.
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 500 AVE DEGETAU STE 414 500 AVE DEGETAU
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City | CAGUAS
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State | PR
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Zip | 00725-7307
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Country | US
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Telephone | 787-258-0614
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Fax | 787-961-4663
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Provider Business Mailing Address
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Address Line | 500 AVE DEGETAU HIMA PLAZA ONE STE 414
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-258-0614
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Fax | 787-961-4663
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Authorized Official
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Title or Position | PRESIDENT
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Name | LIANETTE M PEREZ
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Credential | M.D
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Telephone | 787-258-0614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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