Provider Demographics
NPI:1528710241
Name:PEDIATRIC GYNECOLOGY OF PUERTO RICO LLC
Entity type:Organization
Organization Name:PEDIATRIC GYNECOLOGY OF PUERTO RICO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:OQUENDO DEL TORO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-405-6168
Mailing Address - Street 1:3303 CALLE DONA JUANA
Mailing Address - Street 2:EL MONTE
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-405-6168
Mailing Address - Fax:
Practice Address - Street 1:253 SAN JORGE
Practice Address - Street 2:SAN JORGE BUILDING SUITE 403
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00913
Practice Address - Country:US
Practice Address - Phone:787-478-7334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-24
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty