Provider Demographics
NPI:1427476878
Name:OJITOS OFTALMOLOGIA PEDIATRICA CSP
Entity type:Organization
Organization Name:OJITOS OFTALMOLOGIA PEDIATRICA CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-404-2427
Mailing Address - Street 1:200 CALLE HERNANDEZ CARRION STE 4301
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-4689
Mailing Address - Country:US
Mailing Address - Phone:939-440-9200
Mailing Address - Fax:939-440-9222
Practice Address - Street 1:200 CALLE HERNANDEZ CARRION STE 4301
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4689
Practice Address - Country:US
Practice Address - Phone:939-440-9200
Practice Address - Fax:939-440-9222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15390207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1164670980OtherNPPES