Healthcare Provider Details

I. General information

NPI: 1033630744
Provider Name (Legal Business Name): PEDIATRICS HEALTHCARE PROVIDERS PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N25 CALLE 3 VILLA VENECIA
CAROLINA PR
00983
US

IV. Provider business mailing address

N25 CALLE 3 VILLA VENECIA
CAROLINA PR
00983
US

V. Phone/Fax

Practice location:
  • Phone: 787-613-0273
  • Fax:
Mailing address:
  • Phone: 787-613-0273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9992
License Number State

VIII. Authorized Official

Name: DR. VICTOR M MONTANEZ
Title or Position: PRESIDENTE
Credential: MD1992764617
Phone: 787-447-4835