Provider Demographics
NPI:1124522347
Name:CENTRO DE PEDIATRIA INTEGRADO
Entity type:Organization
Organization Name:CENTRO DE PEDIATRIA INTEGRADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-649-8660
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-0026
Mailing Address - Country:US
Mailing Address - Phone:787-649-8660
Mailing Address - Fax:
Practice Address - Street 1:P63 AVE SANTA JUANITA
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4954
Practice Address - Country:US
Practice Address - Phone:787-288-7920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13803261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care