Provider Demographics
NPI:1063891927
Name:CENTRO OBSTETRICIA Y GINECOLOGIA
Entity type:Organization
Organization Name:CENTRO OBSTETRICIA Y GINECOLOGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:DIAZ BRETANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-703-5353
Mailing Address - Street 1:PO BOX 785
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-0785
Mailing Address - Country:US
Mailing Address - Phone:787-703-5353
Mailing Address - Fax:787-957-7052
Practice Address - Street 1:195 CALLE GAUTIER BENITEZ
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-5509
Practice Address - Country:US
Practice Address - Phone:787-703-5353
Practice Address - Fax:787-957-7052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12787207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH55603Medicare UPIN