Healthcare Provider Details

I. General information

NPI: 1457901514
Provider Name (Legal Business Name): KIDS ENDO PR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 AVE LAS CUMBRES STE 14
GUAYNABO PR
00969-4833
US

IV. Provider business mailing address

9 AVE LAS CUMBRES STE 14
GUAYNABO PR
00969-4833
US

V. Phone/Fax

Practice location:
  • Phone: 787-400-2440
  • Fax:
Mailing address:
  • Phone: 787-400-2440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARINA C RUIZ-MONTILLA
Title or Position: MANAGER
Credential: MD
Phone: 787-349-9179