Provider Demographics
NPI:1457633448
Name:STAR KIDS CLUB-CBS PREDIATRIC
Entity Type:Organization
Organization Name:STAR KIDS CLUB-CBS PREDIATRIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCESCHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-946-9693
Mailing Address - Street 1:101 AVE SAN PATRICIO
Mailing Address - Street 2:MARAMAR PLAZA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-2645
Mailing Address - Country:US
Mailing Address - Phone:787-474-0400
Mailing Address - Fax:
Practice Address - Street 1:101 AVE SAN PATRICIO
Practice Address - Street 2:MARAMAR PLAZA
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-2645
Practice Address - Country:US
Practice Address - Phone:787-474-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1128302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization