Provider Demographics
NPI:1811286263
Name:CENTRO DE MEDICINA PEDIATRICA DEL NORTE
Entity type:Organization
Organization Name:CENTRO DE MEDICINA PEDIATRICA DEL NORTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:MALAVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-203-5558
Mailing Address - Street 1:PMB 513 BOX 819
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669
Mailing Address - Country:US
Mailing Address - Phone:787-203-5558
Mailing Address - Fax:787-897-2521
Practice Address - Street 1:PMB 513 BOX 819
Practice Address - Street 2:
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669
Practice Address - Country:US
Practice Address - Phone:787-203-5558
Practice Address - Fax:787-897-2521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9721261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty