Provider Demographics
NPI:1366804734
Name:METRO OB GYN PSC
Entity type:Organization
Organization Name:METRO OB GYN PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:EDNISE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROMAN RUPERTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-981-4406
Mailing Address - Street 1:HC 03 BOX 5086
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-981-4406
Mailing Address - Fax:787-946-7326
Practice Address - Street 1:303 AVE DOMENECH
Practice Address - Street 2:URB LOS INGENIEROS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-981-4406
Practice Address - Fax:787-946-7326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty