Provider Demographics
NPI:1952314296
Name:EMERGENCY & PEDIATRIC SPECIALISTS OF P.R. PSC
Entity Type:Organization
Organization Name:EMERGENCY & PEDIATRIC SPECIALISTS OF P.R. PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMERGENCIOLOGA
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIBEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-758-2000
Mailing Address - Street 1:130 WINSTON CHURCHILL AVE.
Mailing Address - Street 2:SUITE 1 PMB 108
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6018
Mailing Address - Country:US
Mailing Address - Phone:787-784-8139
Mailing Address - Fax:787-784-8139
Practice Address - Street 1:130 AVE WINSTON CHURCHILL
Practice Address - Street 2:SUITE 1 PMB 108
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6013
Practice Address - Country:US
Practice Address - Phone:787-784-8139
Practice Address - Fax:787-784-8139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0081871Medicare ID - Type UnspecifiedEMERGENCIOLOGO