Healthcare Provider Details

I. General information

NPI: 1295907228
Provider Name (Legal Business Name): AMPEDS PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 07/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL WILMA VAZQUEZ DEPARTAMENTO DE PEDIATRIA
VEGA BAJA PR
00693
US

IV. Provider business mailing address

1357 ASHFORD AVE PMB 427
SAN JUAN PR
00907
US

V. Phone/Fax

Practice location:
  • Phone: 787-858-1580
  • Fax: 787-977-8008
Mailing address:
  • Phone: 787-525-9700
  • Fax: 787-977-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13281
License Number StatePR

VIII. Authorized Official

Name: AITZA REYES SEDA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-525-9700