Healthcare Provider Details

I. General information

NPI: 1114122900
Provider Name (Legal Business Name): PEDIATRIX MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PDA 37 AVE PONCE DE LEON
SAN JUAN PR
00902
US

IV. Provider business mailing address

PO BOX 3916
GUAYNABO PR
00970-3916
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2000
  • Fax: 787-758-8519
Mailing address:
  • Phone: 787-999-0753
  • Fax: 787-999-0790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number9989
License Number StatePR

VIII. Authorized Official

Name: DORIS SAURE
Title or Position: BILLING MANAGER
Credential:
Phone: 787-999-0753