Healthcare Provider Details

I. General information

NPI: 1225254287
Provider Name (Legal Business Name): SECCION A NINOS CON NECESIDADES ESPECIALES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO PEDIATRICO DE FAJARDO CALLE E SUITE 77 URB MONTEBRISAS
FAJARDO PR
00738
US

IV. Provider business mailing address

CENTRO PEDIATRICO DE FAJARDO CALLE E SUITE 77 URB MONTEBRISAS
FAJARDO PR
00738
US

V. Phone/Fax

Practice location:
  • Phone: 787-704-7066
  • Fax: 787-746-2898
Mailing address:
  • Phone: 787-704-7066
  • Fax: 787-746-2898

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: DIRETOR EJECUTIVO
Credential: MPA
Phone: 787-771-2100