Healthcare Provider Details

I. General information

NPI: 1154446037
Provider Name (Legal Business Name): SECCION A NINOS CON NECESIDADES ESPECIALES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 11/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO PEDIATRICO DE ARECIBO CARR. 129 ANTIGUO HOSPITAL DE DISTRITO
ARECIBO PR
00612-3666
US

IV. Provider business mailing address

CENTRO PEDIATRICO DE ARECIBO AVENIDA SAN LUIS # 621
ARECIBO PR
00616-3666
US

V. Phone/Fax

Practice location:
  • Phone: 787-817-1245
  • Fax: 787-879-9026
Mailing address:
  • Phone: 787-817-1245
  • Fax: 787-879-9026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StatePR

VIII. Authorized Official

Name: MRS. CARMEN R RODRIGUEZ
Title or Position: DIRECTORA EJECUTIVA
Credential: MPA
Phone: 787-771-2100