Provider Demographics
NPI:1306098686
Name:SECCION A NINOS CON NECESIDADES ESPECIALES
Entity type:Organization
Organization Name:SECCION A NINOS CON NECESIDADES ESPECIALES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTORA EJECUTIVA
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:787-771-2100
Mailing Address - Street 1:AVENIDA TITO CASTRO 931 CARR. 14 BO. MACHUELO
Mailing Address - Street 2:CENTRO PEDIATRICO DE PONCE
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-842-5884
Mailing Address - Fax:787-842-5802
Practice Address - Street 1:CENTRO PEDIATRICO PONCE 931 CARR 14
Practice Address - Street 2:BO MACHUELO AVENIDA TITO CASTRO
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4717
Practice Address - Country:US
Practice Address - Phone:787-842-5884
Practice Address - Fax:787-842-5802
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRO DE VACUNACION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRS027OtherAUDIOLOGIA
PR433CPPOtherMEDICO
PR660433481-4GOtherGENETICISTA
PR88754OtherMEDICO
PRS013OtherPEDIATRA
PR2116-5OtherALIADOS
PR660433481-4POtherOFTALMOLOGIA
PR53438OtherSERVICIOS ALIADOS