1952314296 NPI number — EMERGENCY & PEDIATRIC SPECIALISTS OF P.R. PSC

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 1952314296 NPI number — EMERGENCY & PEDIATRIC SPECIALISTS OF P.R. PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERGENCY & PEDIATRIC SPECIALISTS OF P.R. PSC
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:
1952314296
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:
130 WINSTON CHURCHILL AVE.
Provider Second Line Business Mailing Address:
SUITE 1 PMB 108
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926-6018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-784-8139
Provider Business Mailing Address Fax Number:
787-784-8139

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 AVE WINSTON CHURCHILL
Provider Second Line Business Practice Location Address:
SUITE 1 PMB 108
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00926-6013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-784-8139
Provider Business Practice Location Address Fax Number:
787-784-8139
Provider Enumeration Date:
08/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ MARTINEZ
Authorized Official First Name:
MARIBEL
Authorized Official Middle Name:
Authorized Official Title or Position:
EMERGENCIOLOGA
Authorized Official Telephone Number:
787-758-2000

Provider Taxonomy Codes

  • Taxonomy code: 282NC2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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