Provider Demographics
NPI:1710109384
Name:JDO SERVICIOS PEDIATRICOS DE SUR
Entity Type:Organization
Organization Name:JDO SERVICIOS PEDIATRICOS DE SUR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:DOMINGO
Authorized Official - Last Name:ORTIZ RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-866-8301
Mailing Address - Street 1:66 PARQ INTERAMERICANA
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784-7337
Mailing Address - Country:US
Mailing Address - Phone:787-866-8301
Mailing Address - Fax:
Practice Address - Street 1:HOSP EPISCOPAL CRISTO REDENTOR
Practice Address - Street 2:AVE ALBIZU CAMPOS
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-866-8301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11176208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR85083OtherTRIPLE-S PROVIDERS NUMBER