Healthcare Provider Details

I. General information

NPI: 1629439641
Provider Name (Legal Business Name): PEDIATRIC CARE PR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 CALLE GEORGETTI
SAN JUAN PR
00925-3607
US

IV. Provider business mailing address

PO BOX 41234
SAN JUAN PR
00940-1234
US

V. Phone/Fax

Practice location:
  • Phone: 787-450-9090
  • Fax:
Mailing address:
  • Phone: 787-450-9090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13897
License Number StatePR

VIII. Authorized Official

Name: DR. OLGA M LLITERAS
Title or Position: PRESIDENTA
Credential: M.D
Phone: 787-375-9090