Provider Demographics
NPI:1659581221
Name:CLINICA DE TERAPIAS PEDIATRICAS
Entity Type:Organization
Organization Name:CLINICA DE TERAPIAS PEDIATRICAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTORA Y ADMINISTRADORA
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:RIVERA
Authorized Official - Last Name:RUBIANY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-743-3385
Mailing Address - Street 1:ACUAMARINA STREET #66
Mailing Address - Street 2:VILLA BLANCA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-743-3385
Mailing Address - Fax:787-743-1030
Practice Address - Street 1:ACUAMARINA STREET #66
Practice Address - Street 2:VILLA BLANCA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-743-3385
Practice Address - Fax:787-743-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR50084174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty