Healthcare Provider Details

I. General information

NPI: 1881841260
Provider Name (Legal Business Name): PEDIATRIC SURGICAL SERVICES PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 08/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAN JORGE HOSPITAL MEDICAL OFFICE BUILDING #301
SAN JUAN PR
00912
US

IV. Provider business mailing address

400 CALLE CALAF PMB 423
SAN JUAN PR
00918-1314
US

V. Phone/Fax

Practice location:
  • Phone: 787-727-4953
  • Fax:
Mailing address:
  • Phone: 787-396-9245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number9557
License Number StatePR

VIII. Authorized Official

Name: DR. AURELIO SEGUNDO
Title or Position: PRESIDENT
Credential: MD
Phone: 787-396-9245