Provider Demographics
NPI:1043209745
Name:GRUPO PEDIATRICO DE CAGUAS CSP
Entity Type:Organization
Organization Name:GRUPO PEDIATRICO DE CAGUAS CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:YSERN BORRAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-746-2021
Mailing Address - Street 1:PO BOX 8969
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-8969
Mailing Address - Country:US
Mailing Address - Phone:787-746-2021
Mailing Address - Fax:787-746-4248
Practice Address - Street 1:50 AVE MUNOZ MARIN
Practice Address - Street 2:QUADRANGLE MEDICAL CENTER 307
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3975
Practice Address - Country:US
Practice Address - Phone:787-746-2021
Practice Address - Fax:787-746-4248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1376549790Medicare UPIN
PR1174528665Medicare UPIN