Provider Demographics
NPI:1871633842
Name:CENTRO PEDIATRICO METROPOLITANO DE SERVICIOS DE HABILITACION
Entity Type:Organization
Organization Name:CENTRO PEDIATRICO METROPOLITANO DE SERVICIOS DE HABILITACION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHAVEZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRIAM
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-763-0550
Mailing Address - Street 1:PO BOX 191079
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-1079
Mailing Address - Country:US
Mailing Address - Phone:787-763-0550
Mailing Address - Fax:787-763-1093
Practice Address - Street 1:HOSPITAL PEDIATRICO UNIVERSITARIO
Practice Address - Street 2:CENTRO MEDICO DE PUERTO RICO
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00919-1079
Practice Address - Country:US
Practice Address - Phone:787-763-0550
Practice Address - Fax:787-763-1093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR40 CNC NUM 93-060261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities