Provider Demographics
NPI:1992586481
Name:OBSTETRICS AND GYNECOLOGY HEALTH CENTER LLC
Entity type:Organization
Organization Name:OBSTETRICS AND GYNECOLOGY HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:I
Authorized Official - Last Name:MONTALVO-MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-467-2259
Mailing Address - Street 1:1255 PASEO LAS MONJITAS SUITE M161
Mailing Address - Street 2:AVE TITO CASTRO
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730
Mailing Address - Country:US
Mailing Address - Phone:787-651-7816
Mailing Address - Fax:787-651-7822
Practice Address - Street 1:1255 PASEO LAS MONJITAS
Practice Address - Street 2:SUITE M161 AVE TITO CASTRO
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730
Practice Address - Country:US
Practice Address - Phone:787-651-7816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty