Healthcare Provider Details

I. General information

NPI: 1457505836
Provider Name (Legal Business Name): SERVICIOS EMERGENCIAS PEDIATRICAS INTEGRADOS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR #2 KM 47.7
MANATI PR
00674
US

IV. Provider business mailing address

PO BOX 12
MANATI PR
00674-0012
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-3322
  • Fax:
Mailing address:
  • Phone: 787-391-3924
  • Fax: 787-854-4213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RALPH DIAZ COLON
Title or Position: PRESIDENT
Credential: MD
Phone: 787-391-3924