Healthcare Provider Details

I. General information

NPI: 1700158391
Provider Name (Legal Business Name): SAN JORGE PEDIATRIC ORTHOPAEDIC INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAN JORGE CORPORATE BUILDING 2B SAN JORGE 253
SAN JUAN PR
00912
US

IV. Provider business mailing address

SAN JORGE CORPORATE BUILDING 2B CALLE SAN JORGE 253
SAN JUAN PR
00912
US

V. Phone/Fax

Practice location:
  • Phone: 787-727-1000
  • Fax: 787-268-3610
Mailing address:
  • Phone: 787-727-1000
  • Fax: 787-268-3610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number64
License Number StatePR

VIII. Authorized Official

Name: MS. AMAIRA NIEVES
Title or Position: CREDIT MANAGER
Credential:
Phone: 787-727-1000