Provider Demographics
NPI:1912367772
Name:SERVICIOS MEDICOS PEDIATRICOS
Entity Type:Organization
Organization Name:SERVICIOS MEDICOS PEDIATRICOS
Other - Org Name:CSP
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:DR
Authorized Official - First Name:SOL
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-519-1764
Mailing Address - Street 1:17 CALLE CIBELES Y PRINCIPAL
Mailing Address - Street 2:EXT.EL RETIRO
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-4459
Mailing Address - Country:US
Mailing Address - Phone:787-892-8899
Mailing Address - Fax:787-892-8899
Practice Address - Street 1:17 MAIN AND CALLE CIBELES
Practice Address - Street 2:EL RETIRO HOUSING
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4459
Practice Address - Country:US
Practice Address - Phone:787-892-8899
Practice Address - Fax:787-892-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15351261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty