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General NPI Number Information
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NPI Number | 1811286263
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Entity Type | Organization
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Legal Business Name | CENTRO DE MEDICINA PEDIATRICA DEL NORTE
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Dates
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Enumeration Date | 04/06/2011
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Last Update Date | 04/06/2011
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Provider Practice Location Address
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Address Line | PMB 513 BOX 819
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City | LARES
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State | PR
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Zip | 00669
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Country | US
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Telephone | 787-203-5558
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Fax | 787-897-2521
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Provider Business Mailing Address
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Address Line | PMB 513 BOX 819
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City | LARES
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State | PR
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Zip | 00669
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Country | US
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Telephone | 787-203-5558
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Fax | 787-897-2521
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIE NELSON MALAVE
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Credential | M.D.
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Telephone | 787-203-5558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 9721
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License Number State | PR
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