Healthcare Provider Details

I. General information

NPI: 1528712692
Provider Name (Legal Business Name): PEDIATRIX CARIBBEAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 02/08/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

METRO OFFICE PARK # 6 ST 1 SUITE 202
GUAYNABO PR
00968
US

IV. Provider business mailing address

PO BOX 11913
SAN JUAN PR
00922-1913
US

V. Phone/Fax

Practice location:
  • Phone: 787-999-0753
  • Fax: 787-999-0790
Mailing address:
  • Phone: 787-999-0753
  • Fax: 787-999-0790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLOS A PEREZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-999-0753