Provider Demographics
NPI:1477537892
Name:GRUPO INTENSIVO PEDIATRICO DE SAN JUAN
Entity Type:Organization
Organization Name:GRUPO INTENSIVO PEDIATRICO DE SAN JUAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:RODRIGUEZ-SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-726-0210
Mailing Address - Street 1:252 CALLE SAN JORGE
Mailing Address - Street 2:MEDICAL OFFICE BUILDING SUITE 406
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00912-3310
Mailing Address - Country:US
Mailing Address - Phone:787-726-0210
Mailing Address - Fax:787-728-5136
Practice Address - Street 1:252 CALLE SAN JORGE
Practice Address - Street 2:MEDICAL OFFICE BUILDING SUITE 406
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912-3310
Practice Address - Country:US
Practice Address - Phone:787-726-0210
Practice Address - Fax:787-728-5136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89351OtherTRIPLE S