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General NPI Number Information
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NPI Number | 1235271370
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Entity Type | Organization
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Legal Business Name | LITTLE ANGELS PEDIATRIC GROUP PSC
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | CARR. 931 KM. 5.4 ALTOS SUITE #2 BO. NAVARRO
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City | GURABO
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State | PR
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Zip | 00778
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Country | US
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Telephone | 787-747-0300
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Fax | 787-747-0300
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Provider Business Mailing Address
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Address Line | HC- 02 13066 BO. NAVARRO, COLINAS DE NAVARRO
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City | GURABO
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State | PR
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Zip | 00778-3066
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Country | US
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Telephone | 787-747-0300
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Fax | 787-747-0300
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Authorized Official
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Title or Position | PEDIATRITIAN
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Name | DR. MICHELLE MORINGLANE
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Credential | M.D.
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Telephone | 787-747-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 11228
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 13537
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License Number State | PR
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