Provider Demographics
NPI:1770522856
Name:RECINTO DE CIENCIAS MEDICAS
Entity type:Organization
Organization Name:RECINTO DE CIENCIAS MEDICAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:RHIA
Authorized Official - Phone:787-758-2525
Mailing Address - Street 1:PO BOX 29134
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0134
Mailing Address - Country:US
Mailing Address - Phone:787-758-2525
Mailing Address - Fax:787-274-8156
Practice Address - Street 1:AVE. AMERICO MIRANDA CENTRO MEDICO DE PUERTO RICO
Practice Address - Street 2:EDIF. PRINCIPAL RCM PISO 5 APARTADO 29134
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00929-0134
Practice Address - Country:US
Practice Address - Phone:787-758-2525
Practice Address - Fax:787-274-8156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207LP2900X, 207LP3000X
PR207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric AnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
----01OtherPPMI GROUP
----01OtherPPMI GROUP