Provider Demographics
NPI:1265577597
Name:KIDSHEALTH PSC
Entity type:Organization
Organization Name:KIDSHEALTH PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES SEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-525-9700
Mailing Address - Street 1:1357 AVE ASHFORD
Mailing Address - Street 2:PMB 427
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1400
Mailing Address - Country:US
Mailing Address - Phone:787-525-9700
Mailing Address - Fax:787-977-8010
Practice Address - Street 1:HOSPITAL WILMA VAZQUEZ
Practice Address - Street 2:SUITE 107
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-0000
Practice Address - Country:US
Practice Address - Phone:787-621-5607
Practice Address - Fax:787-977-8010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherEIN #