Provider Demographics
NPI:1942424338
Name:SECCION A NINOS CON NECESIDADES ESPECIALES
Entity Type:Organization
Organization Name:SECCION A NINOS CON NECESIDADES ESPECIALES
Other - Org Name:CENTRO PEDIATRICO DE MAYAGUEZ
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR EJECUTIVA
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:787-771-2100
Mailing Address - Street 1:CENTRO PEDIATRICO DE MAYAGUEZ
Mailing Address - Street 2:410 AVE HOSTOS, SUITE #1
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-1522
Mailing Address - Country:US
Mailing Address - Phone:787-832-6015
Mailing Address - Fax:787-832-6015
Practice Address - Street 1:CENTRO PEDIATRICO DE MAYAGUEZ
Practice Address - Street 2:410 AVE HOSTOS, SUITE #1
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1522
Practice Address - Country:US
Practice Address - Phone:787-832-6015
Practice Address - Fax:787-832-6015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR00433CPMOtherMEDICO Y ALIADOS
PR3156-1OtherMEDICO Y ALIADOS
PRP6044OtherPATOLOGIA DEL HABLA
PR120537OtherMEDICOS Y ALIADOS
PRS020OtherORTOPEDIA
PR81394OtherALIADOS
PRP5174OtherPSICOLOGA
PR10005OtherMEDICO Y ALIADOS
PR6800103OtherMEDICOS Y ALIADOS
PRC017OtherPEDIATRA
PRS018OtherOFTALMOLOGO
PRS022OtherAUDIOLOGIA
PR660433481-2OtherMEDICOS
PR88755OtherMEDICOS
PRS021OtherFISIOTERAPIA
PR203699OtherMEDICOS Y ALIADOS
PRM0520OtherMEDICO
PRP0051OtherAUDIOLOGA
PRS019OtherCIRUJANO