Healthcare Provider Details

I. General information

NPI: 1346961448
Provider Name (Legal Business Name): ELITE PEDS ENDOCRINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 09/07/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 AVE. PONDE DE LEON SUITE 205
SANTURCE PR
00909
US

IV. Provider business mailing address

300 AVE LA SIERRA APT 187
SAN JUAN PR
00926-4362
US

V. Phone/Fax

Practice location:
  • Phone: 939-475-1414
  • Fax:
Mailing address:
  • Phone: 787-565-8828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHEILA DENISE PEREZ COLON
Title or Position: PEDIATRIC ENDOCRINOLOGIST
Credential: MD
Phone: 787-565-8628