Provider Demographics
NPI:1881841260
Name:PEDIATRIC SURGICAL SERVICES PSC
Entity Type:Organization
Organization Name:PEDIATRIC SURGICAL SERVICES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AURELIO
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGUNDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-396-9245
Mailing Address - Street 1:400 CALLE CALAF PMB 423
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1314
Mailing Address - Country:US
Mailing Address - Phone:787-396-9245
Mailing Address - Fax:
Practice Address - Street 1:SAN JORGE HOSPITAL MEDICAL OFFICE BUILDING #301
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912
Practice Address - Country:US
Practice Address - Phone:787-727-4953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR95572086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Single Specialty