Provider Demographics
NPI:1649227422
Name:CENTRAL PEDIATRIC GROUP, C.S.P.
Entity Type:Organization
Organization Name:CENTRAL PEDIATRIC GROUP, C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:F
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-743-2115
Mailing Address - Street 1:18 CALLE TAFT
Mailing Address - Street 2:APT 5-S
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911-1200
Mailing Address - Country:US
Mailing Address - Phone:787-743-2115
Mailing Address - Fax:787-744-3800
Practice Address - Street 1:18 CALLE TAFT
Practice Address - Street 2:5-S
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00911-1200
Practice Address - Country:US
Practice Address - Phone:787-743-2115
Practice Address - Fax:787-744-3800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty