Provider Demographics
NPI:1851457774
Name:CENTRO DE ESPECIALISTAS PEDIATRICOS
Entity Type:Organization
Organization Name:CENTRO DE ESPECIALISTAS PEDIATRICOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RENATO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-746-3534
Mailing Address - Street 1:PO BOX 9442
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-9442
Mailing Address - Country:US
Mailing Address - Phone:787-746-3534
Mailing Address - Fax:787-258-8129
Practice Address - Street 1:D3 AVE DEGETAU
Practice Address - Street 2:SAN ALFONSO
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-5838
Practice Address - Country:US
Practice Address - Phone:787-746-3534
Practice Address - Fax:787-258-8129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6907174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty