Provider Demographics
NPI:1265893846
Name:CENTRO PEDIATRICO DE HATILLO CSP
Entity type:Organization
Organization Name:CENTRO PEDIATRICO DE HATILLO CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:MALAVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-650-0333
Mailing Address - Street 1:PO BOX 819
Mailing Address - Street 2:PMB 513
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669
Mailing Address - Country:US
Mailing Address - Phone:787-650-0333
Mailing Address - Fax:
Practice Address - Street 1:CARR 493 KM 0.5 BO. CARRIZALES
Practice Address - Street 2:LOCAL 126
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-650-0333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty