Provider Demographics
NPI:1225208051
Name:NAEM PEDIATRIC GROUP PSC
Entity Type:Organization
Organization Name:NAEM PEDIATRIC GROUP PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DRISDE
Authorized Official - Middle Name:I
Authorized Official - Last Name:CRUZ-MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-805-3131
Mailing Address - Street 1:PO BOX 957
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0957
Mailing Address - Country:US
Mailing Address - Phone:787-805-3131
Mailing Address - Fax:787-805-3131
Practice Address - Street 1:351 AVENIDA HOSTOS
Practice Address - Street 2:SUITE 412 MEDICAL EMPORIUM
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1504
Practice Address - Country:US
Practice Address - Phone:787-805-3131
Practice Address - Fax:787-805-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14520174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty