Provider Demographics
NPI:1295409464
Name:CENTRO DE ENDOCRINOLOGIA PEDRIATICA Y DIABETE DEL OESTE
Entity Type:Organization
Organization Name:CENTRO DE ENDOCRINOLOGIA PEDRIATICA Y DIABETE DEL OESTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-607-9637
Mailing Address - Street 1:HC 9 BOX 10521
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-9306
Mailing Address - Country:US
Mailing Address - Phone:787-882-6879
Mailing Address - Fax:
Practice Address - Street 1:CARR 110
Practice Address - Street 2:BO CORALEZ
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-0060
Practice Address - Country:US
Practice Address - Phone:787-882-6879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRO DE ENDOCRINOLOGIA PEDIATRICA Y DIABEETE DEL OESTE L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service