MEDICARE: CENTRO PEDIATRICO COTO PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	6715	PR

General Provider Information

NPI Number	:	1346663937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRO PEDIATRICO COTO PSC

Provider Business Mailing Address
First Line	:	PO BOX 801220
Second Line	:
City	:	COTO LAUREL
State	:	PR
Zip	:	00780-1220
Country	:	US
Telephone Number	:	787-636-9217
Fax Number	:	787-837-4000

Provider Business Practice Location Address
First Line	:	7 CALLE LA CRUZ
Second Line	:
City	:	JUANA DIAZ
State	:	PR
Zip	:	00795-2426
Country	:	US
Telephone Number	:	787-837-4000
Fax Number	:	787-837-4000

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JUAN RODRIGUEZ
Credential	:	MD
Telephone Number	:	787-636-9217

Provider Enumeration Date	:	02/03/2014
Last Update Date	:	02/03/2014

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