=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912172602
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PCR INTERNAL MEDICINE P.S.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2008
-----------------------------------------------------
Last Update Date | 02/22/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | EXTENCION FOREST HILLS E 55 CALLE MARGINAL
-----------------------------------------------------
City | BAYAMON
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-779-8311
-----------------------------------------------------
Fax | 787-779-8311
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | URBANIZACION SANTA JUANITA PMB 206 UU 1 CALLE 39
-----------------------------------------------------
City | BAYAMON
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-779-8311
-----------------------------------------------------
Fax | 787-779-8311
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. PILAR CABRERA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 787-779-8311
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 11842
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------