Provider Demographics
NPI:1457901514
Name:KIDS ENDO PR
Entity Type:Organization
Organization Name:KIDS ENDO PR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:C
Authorized Official - Last Name:RUIZ-MONTILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-349-9179
Mailing Address - Street 1:9 AVE LAS CUMBRES STE 14
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4833
Mailing Address - Country:US
Mailing Address - Phone:787-400-2440
Mailing Address - Fax:
Practice Address - Street 1:9 AVE LAS CUMBRES STE 14
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4833
Practice Address - Country:US
Practice Address - Phone:787-400-2440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Single Specialty