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NPI Code Detail

MEDICARE: SAN JORGE CHILDRENS MEDICAL SPEIALTIES

MEDICARE: SAN JORGE CHILDRENS MEDICAL SPEIALTIES
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
1174400000XSpecialist11147PR
2174400000XSpecialist5762PR
3174400000XSpecialist9083PR
4174400000XSpecialist9183PR
5174400000XSpecialist12902PR
6174400000XSpecialist13693PR
72080P0207XPediatric Hematology & Oncology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
112501OTHERPRTRIPLE S
220062OTHERPRTRIPLE S
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689981888
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAN JORGE CHILDRENS MEDICAL SPEIALTIES
Provider Business Mailing Address
First Line : 252 CALLE SAN JORGE
Second Line : SAN JORGE MEDICAL BLDG 504
City : SANTURCE
State : PR
Zip : 00912-3239
Country : US
Telephone Number : 787-728-1575
Fax Number : 787-726-0402
Provider Business Practice Location Address
First Line : 252 CALLE SAN JORGE STE 504
Second Line :
City : SAN JUAN
State : PR
Zip : 00912-3241
Country : US
Telephone Number : 787-728-1575
Fax Number : 787-726-0402
Authorized Official
Title or Position : ADMIN
Name : CARMEN L VELEZ
Credential :
Telephone Number : 787-728-1575
Provider Enumeration Date : 09/09/2010
Last Update Date : 08/07/2024

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Directions to “SAN JORGE CHILDRENS MEDICAL SPEIALTIES ” Practice Location

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