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General NPI Number Information
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NPI Number | 1851457774
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Entity Type | Organization
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Legal Business Name | CENTRO DE ESPECIALISTAS PEDIATRICOS
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | D3 AVE DEGETAU SAN ALFONSO
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City | CAGUAS
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State | PR
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Zip | 00725-5838
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Country | US
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Telephone | 787-746-3534
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Fax | 787-258-8129
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Provider Business Mailing Address
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Address Line | PO BOX 9442
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City | CAGUAS
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State | PR
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Zip | 00726-9442
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Country | US
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Telephone | 787-746-3534
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Fax | 787-258-8129
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RENATO RIVERA
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Credential |
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Telephone | 787-746-3534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 6907
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License Number State | PR
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