Healthcare Provider Details

I. General information

NPI: 1699763102
Provider Name (Legal Business Name): PEPINO HEALTH GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 03/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 CALLE PAVIA FERNANDEZ
SAN SEBASTIAN PR
00685-2285
US

IV. Provider business mailing address

PO BOX 1537
SAN SEBASTIAN PR
00685-1537
US

V. Phone/Fax

Practice location:
  • Phone: 787-280-1335
  • Fax: 787-280-1335
Mailing address:
  • Phone: 787-280-1335
  • Fax: 787-280-1335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JIMMY OLIVERA
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-280-1335