Provider Demographics
NPI:1508131988
Name:GO PEDIATRICS PSC
Entity Type:Organization
Organization Name:GO PEDIATRICS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEJIA VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-366-7726
Mailing Address - Street 1:130 AVE WINSTON CHURCHILL
Mailing Address - Street 2:PMB 364 STE 1
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6065
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 LAS CUMBRES SHOPP CTR # AVE
Practice Address - Street 2:CARR 199 KM 0 3
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5406
Practice Address - Country:US
Practice Address - Phone:787-300-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care