Healthcare Provider Details

I. General information

NPI: 1255319703
Provider Name (Legal Business Name): PEDIATRIX MEDICAL GROUP OF PUERTO RICO, P.S.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 AVE SAN LUIS
ARECIBO PR
00612-3637
US

IV. Provider business mailing address

PO BOX 11913
SAN JUAN PR
00922-1913
US

V. Phone/Fax

Practice location:
  • Phone: 787-650-7273
  • Fax:
Mailing address:
  • Phone: 787-999-0753
  • Fax: 787-651-1794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number StatePR

VIII. Authorized Official

Name: SANDY VELAZQUEZ
Title or Position: BILLING, COLLECTIONS & HA SUPERVISO
Credential:
Phone: 787-999-0753