Provider Demographics
NPI:1366863698
Name:PEDIATRIC PROFESSIONALS, CSP
Entity Type:Organization
Organization Name:PEDIATRIC PROFESSIONALS, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:MILAGROS
Authorized Official - Middle Name:T
Authorized Official - Last Name:REYES MORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-924-7575
Mailing Address - Street 1:PO BOX 8549
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-8549
Mailing Address - Country:US
Mailing Address - Phone:787-924-7575
Mailing Address - Fax:787-924-7575
Practice Address - Street 1:1 AVE CAMPINAS DE NAVARRO
Practice Address - Street 2:URB CAMPINAS DE NAVARRO
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-5500
Practice Address - Country:US
Practice Address - Phone:787-924-7575
Practice Address - Fax:787-924-7575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency MedicineGroup - Multi-Specialty
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency MedicineGroup - Multi-Specialty