Healthcare Provider Details

I. General information

NPI: 1689683526
Provider Name (Legal Business Name): LLITERAS' PEDIATRIC GROUP, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE PONCE DE LEON HOSPITAL AUXILIO MUTUO
SAN JUAN PR
00918-1000
US

IV. Provider business mailing address

587 YUNES ST. PALACIOS DEL RIO I
TOA ALTA PR
00953-5022
US

V. Phone/Fax

Practice location:
  • Phone: 787-375-9090
  • Fax:
Mailing address:
  • Phone: 787-375-9090
  • Fax: 787-999-5559

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: PRESIDENT
Credential:
Phone: 787-375-9090