Healthcare Provider Details

I. General information

NPI: 1295227338
Provider Name (Legal Business Name): SAFARI PEDIATRIC CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR #2 KM 43.3 BO ALGARROBOS
VEGA BAJA PR
00693
US

IV. Provider business mailing address

PO BOX 1507
MANATI PR
00674-1507
US

V. Phone/Fax

Practice location:
  • Phone: 787-654-9532
  • Fax:
Mailing address:
  • Phone: 787-647-2873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18147
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. REBECCA RAMOS
Title or Position: OWNER
Credential: MD
Phone: 787-654-9532