Healthcare Provider Details

I. General information

NPI: 1770536385
Provider Name (Legal Business Name): GRUPO PEDIATRICO MYJ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 AVE WINSTON CHURCHILL PMB 108
SAN JUAN PR
00926-6013
US

IV. Provider business mailing address

130 AVE WINSTON CHURCHILL PMB 108
SAN JUAN PR
00926-6013
US

V. Phone/Fax

Practice location:
  • Phone: 787-755-0595
  • Fax:
Mailing address:
  • Phone: 787-755-0595
  • Fax:

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. JAVIER CUEVAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-755-0595