Provider Demographics
NPI: | 1386037083 |
---|---|
Name: | CENTRO PEDIATRICO HRP,C.S.P |
Entity type: | Organization |
Organization Name: | CENTRO PEDIATRICO HRP,C.S.P |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PEDIATRICIAN |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | HECTOR |
Authorized Official - Middle Name: | CANDIDO |
Authorized Official - Last Name: | RODRIGUEZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 787-256-2045 |
Mailing Address - Street 1: | 65 CALLE CALDERON MUJICA |
Mailing Address - Street 2: | |
Mailing Address - City: | CANOVANAS |
Mailing Address - State: | PR |
Mailing Address - Zip Code: | 00729-3127 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 787-256-2045 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 65 CALLE CALDERON MUJICA |
Practice Address - Street 2: | |
Practice Address - City: | CANOVANAS |
Practice Address - State: | PR |
Practice Address - Zip Code: | 00729-3127 |
Practice Address - Country: | US |
Practice Address - Phone: | 787-256-2045 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-03-05 |
Last Update Date: | 2015-03-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PR | 11582 | 261QM2500X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM2500X | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |