Provider Demographics
NPI:1174645089
Name:SECCION A NINOS CON NECESIDADES ESPECIALES
Entity Type:Organization
Organization Name:SECCION A NINOS CON NECESIDADES ESPECIALES
Other - Org Name:CENTRO PEDIATRICO PONCE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTORA EJECUTIVA
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:RODRIGEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:787-771-2100
Mailing Address - Street 1:CENTRO PEDIATRICO DE PONCE
Mailing Address - Street 2:AVENIDA TITO CASTRO 931 CARR. 14 BO. MACHUELO
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-4717
Mailing Address - Country:US
Mailing Address - Phone:787-842-5884
Mailing Address - Fax:787-842-5802
Practice Address - Street 1:CENTRO PEDIATRICO DE PONCE
Practice Address - Street 2:AVENIDA TITO CASTRO 931 CARR. 14 BO. MACHUELO
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4717
Practice Address - Country:US
Practice Address - Phone:787-842-5884
Practice Address - Fax:787-842-5802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR00433CPPOtherMEDICO Y LAB
PR2116-5OtherSERVICIOS ALIADOS
PR660433481-4POtherOFTALMOLOGIA
PR660433481-4ZOtherNUTRICIONISTA
PR203736OtherMEDICO Y TERAPIAS
PR660433481-4YOtherTERAPIA FISICA
PR88754OtherMEDICOS
PRS013OtherPEDIATRA
PR060523OtherMEDICO Y TERAPIA
PR53438OtherSERVICIOS ALIADOS
PRS027OtherAUDILOGIA
PR10007OtherMEDICO Y TERAPIAS
PR7310274OtherMEDICO Y TERAPIAS
PRS014OtherOFTALMOLOGO
PR660433481-4TOtherPEDIATRA
PR1001531OtherMEDICO TERAPIA
PR2116-1OtherMEDICO
PR660433481-4GOtherGENETISISTA
PRS013OtherPEDIATRA