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General NPI Number Information
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NPI Number | 1841320082
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Entity Type | Organization
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Legal Business Name | CENTRO PEDIATRICO COUNTRY CLUB
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 08/07/2008
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Provider Practice Location Address
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Address Line | GO7 AVE ROBERTO SANCHEZ VILELLA COUTRY CLUB
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City | CAROLINA
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State | PR
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Zip | 00982-2678
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Country | US
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Telephone | 787-769-5500
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Fax | 787-762-9110
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Provider Business Mailing Address
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Address Line | GO7 AVE ROBERTO SANCHEZ VILELLA COUTRY CLUB
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City | CAROLINA
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State | PR
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Zip | 00982-2678
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Country | US
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Telephone | 787-769-5500
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Fax | 787-762-9110
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. RICARDO MANUEL FONTANET
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Credential | M.D.
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Telephone | 787-769-5500
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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 |
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License Number State |
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