Provider Demographics
NPI:1396835278
Name:SERVICIOS MEDICOS ESPECIALIZADOS DEL PEPINO INC
Entity Type:Organization
Organization Name:SERVICIOS MEDICOS ESPECIALIZADOS DEL PEPINO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:G
Authorized Official - Last Name:NIEVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-280-1469
Mailing Address - Street 1:126 CALLE PAVIA FERNANDEZ
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-2285
Mailing Address - Country:US
Mailing Address - Phone:787-280-1469
Mailing Address - Fax:787-280-1469
Practice Address - Street 1:126 CALLE PAVIA FERNANDEZ
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-2285
Practice Address - Country:US
Practice Address - Phone:787-280-1469
Practice Address - Fax:787-280-1469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0020164Medicare ID - Type Unspecified