Provider Demographics
NPI:1164629275
Name:GRUPO DE PEDIATRIA FACULTAD MEDICA HOSPITAL MUNICIPAL SAN JUAN
Entity Type:Organization
Organization Name:GRUPO DE PEDIATRIA FACULTAD MEDICA HOSPITAL MUNICIPAL SAN JUAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PREDIDENTE COMITE LEY 56
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-766-2222
Mailing Address - Street 1:PMB 101 BOX 70344
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936
Mailing Address - Country:US
Mailing Address - Phone:787-766-2222
Mailing Address - Fax:787-765-4975
Practice Address - Street 1:HOSPITAL MUNICIPAL 3 PISO
Practice Address - Street 2:CENTRO MEDICO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936
Practice Address - Country:US
Practice Address - Phone:787-766-2222
Practice Address - Fax:787-765-4975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR28352OtherSSS