Provider Demographics
NPI:1568495190
Name:CENTRO DE CIRUGIA PEDIATRICA
Entity type:Organization
Organization Name:CENTRO DE CIRUGIA PEDIATRICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ODETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PINZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-812-5286
Mailing Address - Street 1:PO BOX 244
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0244
Mailing Address - Country:US
Mailing Address - Phone:787-812-5286
Mailing Address - Fax:787-984-2821
Practice Address - Street 1:SAINT LUKES MEMORIAL HOSPITAL
Practice Address - Street 2:
Practice Address - City:MERCEDITA
Practice Address - State:PR
Practice Address - Zip Code:00715-0244
Practice Address - Country:US
Practice Address - Phone:787-812-5286
Practice Address - Fax:787-984-2821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR110082086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Single Specialty