1649227422 NPI number — CENTRAL PEDIATRIC GROUP, C.S.P.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649227422 NPI number — CENTRAL PEDIATRIC GROUP, C.S.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL PEDIATRIC GROUP, C.S.P.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649227422
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18 CALLE TAFT
Provider Second Line Business Mailing Address:
APT 5-S
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00911-1200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-743-2115
Provider Business Mailing Address Fax Number:
787-744-3800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18 CALLE TAFT
Provider Second Line Business Practice Location Address:
5-S
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00911-1200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-743-2115
Provider Business Practice Location Address Fax Number:
787-744-3800
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOPEZ
Authorized Official First Name:
DIANA
Authorized Official Middle Name:
F
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
787-743-2115

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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