Provider Demographics
NPI:1134308398
Name:CENTRO PEDIATRICO BUENA VISTA, INC.
Entity Type:Organization
Organization Name:CENTRO PEDIATRICO BUENA VISTA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GISSELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-799-9977
Mailing Address - Street 1:KK-7 CALLE 10
Mailing Address - Street 2:URB CANA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957-6232
Mailing Address - Country:US
Mailing Address - Phone:787-799-9977
Mailing Address - Fax:787-799-9977
Practice Address - Street 1:CARR 167 # KM14.8
Practice Address - Street 2:BO. BUENA VISTA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-9212
Practice Address - Country:US
Practice Address - Phone:787-799-9977
Practice Address - Fax:787-799-9977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care