Provider Demographics
NPI:1285879296
Name:GRUPO PEDIATRICO CIUDAD UNIVERSITARIA, CSP
Entity type:Organization
Organization Name:GRUPO PEDIATRICO CIUDAD UNIVERSITARIA, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:PACHECO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-755-4270
Mailing Address - Street 1:1795 CALLE GARDENIA
Mailing Address - Street 2:MANSIONES DE RIO PIEDRAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7212
Mailing Address - Country:US
Mailing Address - Phone:787-755-4270
Mailing Address - Fax:787-755-1122
Practice Address - Street 1:D14 AVE AA
Practice Address - Street 2:CIUDAD UNIVERSITARIA
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-3151
Practice Address - Country:US
Practice Address - Phone:787-755-4270
Practice Address - Fax:787-755-1122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4934174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty