Healthcare Provider Details

I. General information

NPI: 1770883456
Provider Name (Legal Business Name): PEDIATRIC & EMERGENCY MEDICAL SERVICES P.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2010
Last Update Date: 10/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 726 CALLE VILLA ROSALES BO. CAONILLAS
AIBONITO PR
00705
US

IV. Provider business mailing address

PO BOX 1379
AIBONITO PR
00705-1379
US

V. Phone/Fax

Practice location:
  • Phone: 787-735-8001
  • Fax:
Mailing address:
  • Phone: 787-735-8001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RUBEN MENDEZ BENABE
Title or Position: PRESIDENT
Credential:
Phone: 787-946-1863