Provider Demographics
NPI:1225254287
Name:SECCION A NINOS CON NECESIDADES ESPECIALES
Entity Type:Organization
Organization Name:SECCION A NINOS CON NECESIDADES ESPECIALES
Other - Org Name:CENTRO PEDIATRICO DE FAJARDO
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRETOR EJECUTIVO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:787-771-2100
Mailing Address - Street 1:CENTRO PEDIATRICO DE FAJARDO
Mailing Address - Street 2:CALLE E SUITE 77 URB MONTEBRISAS
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:787-704-7066
Mailing Address - Fax:787-746-2898
Practice Address - Street 1:CENTRO PEDIATRICO DE FAJARDO
Practice Address - Street 2:CALLE E SUITE 77 URB MONTEBRISAS
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-704-7066
Practice Address - Fax:787-746-2898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
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
PR600324OtherMEDICOS Y ALIADOS
PR7174OtherMEDICOS
PR53212OtherALIADOS
PR660433481 - 0026OtherMEDICS Y ALIADOS
PR7380038OtherMEDICO Y ALIADOS
PR88737OtherMEDICO
PR2424-5OtherMEDICOS Y ALIADOS
PR660433481-3OtherMEDICO
PR060522OtherMEDICOS Y ALIADOS