Provider Demographics
| NPI: | 1407116684 |
|---|---|
| Name: | SOCIEDAD PRO HOSPITAL DEL NINO |
| Entity Type: | Organization |
| Organization Name: | SOCIEDAD PRO HOSPITAL DEL NINO |
| Other - Org Name: | SOCIEDAD PRO HOSPITAL DEL NINO |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | CHIEF EXECUTIVE OFFICER |
| Authorized Official - Prefix: | MRS |
| Authorized Official - First Name: | VANIA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | MEDINA |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 787-783-2226 |
| Mailing Address - Street 1: | PO BOX 2124 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SAN JUAN |
| Mailing Address - State: | PR |
| Mailing Address - Zip Code: | 00922-2124 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 787-783-2226 |
| Mailing Address - Fax: | 787-783-1325 |
| Practice Address - Street 1: | CARR 1490 KM 0.6 MONACILLO |
| Practice Address - Street 2: | |
| Practice Address - City: | GUAYNABO |
| Practice Address - State: | PR |
| Practice Address - Zip Code: | 00966 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 787-783-2226 |
| Practice Address - Fax: | 787-783-1325 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2012-05-22 |
| Last Update Date: | 2022-04-11 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 103T00000X, 2080P0208X, 2080P0210X, 2084N0400X | ||
| PR | 133N00000X, 207SG0201X, 208000000X, 2080P0205X, 2080P0214X, 225100000X, 225X00000X, 225XP0019X, 235Z00000X, 261QM1300X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 133N00000X | Dietary & Nutritional Service Providers | Nutritionist | Group - Multi-Specialty | |
| No | 207SG0201X | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Genetics (M.D.) | Group - Multi-Specialty |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 2080P0205X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology | Group - Multi-Specialty |
| No | 2080P0208X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Infectious Diseases | Group - Multi-Specialty |
| No | 2080P0210X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Nephrology | Group - Multi-Specialty |
| No | 2080P0214X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology | Group - Multi-Specialty |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 225XP0019X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation | Group - Multi-Specialty |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| PR | 039237700 | Medicaid |
