Provider Demographics
NPI:1144497827
Name:SENORIAL OB GYN GROUP PSC
Entity type:Organization
Organization Name:SENORIAL OB GYN GROUP PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:MIGUEL
Authorized Official - Last Name:MARRERO VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-908-1525
Mailing Address - Street 1:138 AVE W CHURCHILL
Mailing Address - Street 2:PMB #315
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6013
Mailing Address - Country:US
Mailing Address - Phone:787-758-1910
Mailing Address - Fax:787-751-4812
Practice Address - Street 1:1729 CALLE SEGRE
Practice Address - Street 2:URB.RIO PIEDRAS HEIGHT'S
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-3246
Practice Address - Country:US
Practice Address - Phone:787-758-1910
Practice Address - Fax:787-751-4812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD08278Medicare UPIN
PR2-5584Medicare PIN