Provider Demographics
NPI:1831314145
Name:GRUPO PEDIATRICO SAN PATRICIO
Entity Type:Organization
Organization Name:GRUPO PEDIATRICO SAN PATRICIO
Other - Org Name:GRUPO PEDIATRICO SAN PATRICIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:M
Authorized Official - Last Name:SANTIAGO-VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-782-3870
Mailing Address - Street 1:765 AVE SAN PATRICIO
Mailing Address - Street 2:URB. LAS LOMAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-1302
Mailing Address - Country:US
Mailing Address - Phone:787-782-3870
Mailing Address - Fax:
Practice Address - Street 1:765 AVE SAN PATRICIO
Practice Address - Street 2:URB. LAS LOMAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-1302
Practice Address - Country:US
Practice Address - Phone:787-782-3870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6445174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty