Healthcare Provider Details

I. General information

NPI: 1306098686
Provider Name (Legal Business Name): SECCION A NINOS CON NECESIDADES ESPECIALES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 10/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO PEDIATRICO PONCE 931 CARR 14 BO MACHUELO AVENIDA TITO CASTRO
PONCE PR
00716-4717
US

IV. Provider business mailing address

AVENIDA TITO CASTRO 931 CARR. 14 BO. MACHUELO CENTRO PEDIATRICO DE PONCE
PONCE PR
00716
US

V. Phone/Fax

Practice location:
  • Phone: 787-842-5884
  • Fax: 787-842-5802
Mailing address:
  • Phone: 787-842-5884
  • Fax: 787-842-5802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CARMEN R RODRIGUEZ
Title or Position: DIRECTORA EJECUTIVA
Credential: MPA
Phone: 787-771-2100