Provider Demographics
NPI:1235271370
Name:LITTLE ANGELS PEDIATRIC GROUP PSC
Entity Type:Organization
Organization Name:LITTLE ANGELS PEDIATRIC GROUP PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRITIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORINGLANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-747-0300
Mailing Address - Street 1:HC- 02 13066
Mailing Address - Street 2:BO. NAVARRO, COLINAS DE NAVARRO
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-3066
Mailing Address - Country:US
Mailing Address - Phone:787-747-0300
Mailing Address - Fax:787-747-0300
Practice Address - Street 1:CARR. 931 KM. 5.4
Practice Address - Street 2:ALTOS SUITE #2 BO. NAVARRO
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-747-0300
Practice Address - Fax:787-747-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR135372080A0000X
PR112282080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR132BOtherINTERNATIONAL MEDICAL CAR
PR132BOtherINTERNATIONAL MEDICAL CAR
PR132BOtherINTERNATIONAL MEDICAL CAR