Provider Demographics
NPI:1447350384
Name:DOCTORS DELTA OB-GYN GROUP CSP
Entity type:Organization
Organization Name:DOCTORS DELTA OB-GYN GROUP CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANAMARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-854-3115
Mailing Address - Street 1:P.O. BOX-1090
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-854-3115
Mailing Address - Fax:787-884-5016
Practice Address - Street 1:URB ATENAS CALLE HERNANDEZ CARRION
Practice Address - Street 2:MANATI MEDICAL CENTER SUITE 103
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-3115
Practice Address - Fax:787-884-5016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5871207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E21236Medicare UPIN