Healthcare Provider Details

I. General information

NPI: 1467200378
Provider Name (Legal Business Name): RED NOSE PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 05/07/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 AVE OSVALDO MOLINA
FAJARDO PR
00738-4013
US

IV. Provider business mailing address

COND COLLEGE PARK A 100 APT 1204
SAN JUAN PR
00921
US

V. Phone/Fax

Practice location:
  • Phone: 787-801-0081
  • Fax:
Mailing address:
  • Phone: 787-469-7732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. NATALIA RIOS
Title or Position: PRESIDENT
Credential: MD
Phone: 787-801-0081