Healthcare Provider Details

I. General information

NPI: 1932817830
Provider Name (Legal Business Name): AM PEDIATRICS PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE AURELIO BERNAL 40 SAN FELIPE
LARES PR
00936
US

IV. Provider business mailing address

PO BOX 70344
SAN JUAN PR
00936-8344
US

V. Phone/Fax

Practice location:
  • Phone: 787-467-1212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LUIS ACOSTA MONTIJO
Title or Position: OWNER AM PEDIATRICS PSC
Credential: MD
Phone: 787-467-1212