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General NPI Number Information
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NPI Number | 1124522347
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Entity Type | Organization
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Legal Business Name | CENTRO DE PEDIATRIA INTEGRADO
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Dates
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Enumeration Date | 03/21/2018
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Last Update Date | 03/21/2018
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Provider Practice Location Address
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Address Line | P63 AVE SANTA JUANITA
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City | BAYAMON
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State | PR
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Zip | 00956-4954
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Country | US
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Telephone | 787-288-7920
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 26
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City | BAYAMON
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State | PR
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Zip | 00960-0026
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Country | US
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Telephone | 787-649-8660
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Fax |
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Authorized Official
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Title or Position | PEDIATRICIAN
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Name | DR. GLORY MARIE SERRANO
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Credential | MD
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Telephone | 787-649-8660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 13803
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License Number State | PR
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