Healthcare Provider Details

I. General information

NPI: 1508846759
Provider Name (Legal Business Name): BAYAMON PEDIATRIC AND ADOLESCENT MEDICINE SERVICES,PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BAYAMON MEDICAL PLZ SUITE 304
BAYAMON PR
00959-7200
US

IV. Provider business mailing address

PO BOX 2078
GUAYNABO PR
00970-2078
US

V. Phone/Fax

Practice location:
  • Phone: 787-786-1873
  • Fax: 787-622-0024
Mailing address:
  • Phone: 787-786-1873
  • Fax: 787-622-0024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number6155
License Number StatePR

VIII. Authorized Official

Name: DR. LUIS F OLMEDO
Title or Position: PRESIDENT
Credential: MD
Phone: 787-786-1873