Provider Demographics
NPI:1932817830
Name:AM PEDIATRICS PSC
Entity Type:Organization
Organization Name:AM PEDIATRICS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AM PEDIATRICS PSC
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA MONTIJO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-467-1212
Mailing Address - Street 1:PO BOX 70344
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8344
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CALLE AURELIO BERNAL 40
Practice Address - Street 2:SAN FELIPE
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00936
Practice Address - Country:US
Practice Address - Phone:787-467-1212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-09
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty