Provider Demographics
NPI:1760697684
Name:B&G PEDIATRIC GROUP P.S.C.
Entity Type:Organization
Organization Name:B&G PEDIATRIC GROUP P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUITXA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAEZ DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-205-2114
Mailing Address - Street 1:VIA DESTELLO 761
Mailing Address - Street 2:HACIENDA SAN JOSE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-3111
Mailing Address - Country:US
Mailing Address - Phone:787-205-2114
Mailing Address - Fax:787-286-6161
Practice Address - Street 1:HACIENDA SAN JOSE 761 VIA DESTELLO
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-3111
Practice Address - Country:US
Practice Address - Phone:787-205-2114
Practice Address - Fax:787-286-6161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3776174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty