Healthcare Provider Details

I. General information

NPI: 1649227422
Provider Name (Legal Business Name): CENTRAL PEDIATRIC GROUP, C.S.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 CALLE TAFT 5-S
SAN JUAN PR
00911-1200
US

IV. Provider business mailing address

18 CALLE TAFT APT 5-S
SAN JUAN PR
00911-1200
US

V. Phone/Fax

Practice location:
  • Phone: 787-743-2115
  • Fax: 787-744-3800
Mailing address:
  • Phone: 787-743-2115
  • Fax: 787-744-3800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DIANA F LOPEZ
Title or Position: ADMINISTRATOR
Credential: M.D.
Phone: 787-743-2115