MEDICARE: RECINTO DE CIENCIAS MEDICAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	207SG0202X	Clinical Biochemical Genetics Physician	PR
2	207SG0203X	Clinical Molecular Genetics Physician	PR
3	2080P0201X	Pediatric Allergy/Immunology Physician	PR
4	2080P0214X	Pediatric Pulmonology Physician	PR
5	291U00000X	Clinical Medical Laboratory	PR
6	104100000X	Social Worker	PR
7	133VN1004X	Pediatric Nutrition Registered Dietitian	PR
8	133VN1006X	Metabolic Nutrition Registered Dietitian	PR
9	163W00000X	Registered Nurse	PR
10	163WP0200X	Pediatric Registered Nurse	PR
11	164W00000X	Licensed Practical Nurse	PR
12	170300000X	Genetic Counselor (M.S.)
13	207SC0300X	Clinical Cytogenetics Physician	PR
14	207SG0201X	Clinical Genetics (M.D.) Physician	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001	OTHER	PR	PPMI GROUP

General Provider Information

NPI Number	:	1710275144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECINTO DE CIENCIAS MEDICAS

Provider Business Mailing Address
First Line	:	PO BOX 29134
Second Line	:	CENTRO DE ENFERMEDADES HEREDITARIAS DE PR
City	:	SAN JUAN
State	:	PR
Zip	:	00929-0134
Country	:	US
Telephone Number	:	787-754-9165
Fax Number	:	787-274-8156

Provider Business Practice Location Address
First Line	:	OFIC. 563 EDIF. PRINCIPAL RCM
Second Line	:	CENTRO MEDICO DE PUERTO RICO
City	:	RIO PIEDRAS
State	:	PR
Zip	:	00935-0000
Country	:	US
Telephone Number	:	787-754-9165
Fax Number	:	787-274-8156

Authorized Official
Title or Position	:	ADM. SECRETARY
Name	:	SHAYRA C. MORALES
Credential	:
Telephone Number	:	787-754-9165

Provider Enumeration Date	:	07/19/2011
Last Update Date	:	07/19/2011

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