Healthcare Provider Details

I. General information

NPI: 1669506291
Provider Name (Legal Business Name): CLINICA NINOS Y ADOLESCENTES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL PEDIATRICO 4TH FLOOR CENTRO MEDICO
SAN JUAN PR
00922
US

IV. Provider business mailing address

PO BOX 21414
SAN JUAN PR
00928-1414
US

V. Phone/Fax

Practice location:
  • Phone: 787-766-4646
  • Fax:
Mailing address:
  • Phone: 787-766-4640
  • Fax: 787-763-2344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CARLOS ELIAS LUGO
Title or Position: SUPERVISOR
Credential:
Phone: 787-766-4646