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General NPI Number Information
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NPI Number | 1669690418
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Entity Type | Organization
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Legal Business Name | CRANSTON PEDIATRICS LLC DBA PARK PEDIATRICS INC
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 801 PARK AVE
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City | CRANSTON
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State | RI
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Zip | 02910-2036
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Country | US
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Telephone | 401-274-6575
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Fax | 401-273-2597
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Provider Business Mailing Address
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Address Line | 801 PARK AVE
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City | CRANSTON
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State | RI
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Zip | 02910-2036
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Country | US
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Telephone | 401-274-6575
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Fax | 401-273-2597
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICK MANUEL QUILES
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Credential | M.D.
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Telephone | 401-274-6575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD11641
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License Number State | RI
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