Basic Information
| Provider Information | |||||||||
| NPI: | 1174823389 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PLATINUM EMERGENCY KID PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 98 PASEO IBIZA STREET | ||||||||
| Address2: | HACIENDA EL MOLINO | ||||||||
| City: | VEGA ALTA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7873667726 | ||||||||
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| Practice Location | |||||||||
| Address1: | 98 PASEO IBIZA STREET | ||||||||
| Address2: | HACIENDA EL MOLINO | ||||||||
| City: | VEGA ALTA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7873667726 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2010 | ||||||||
| LastUpdateDate: | 10/22/2010 | ||||||||
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| AuthorizedOfficialLastName: | MEJIA | ||||||||
| AuthorizedOfficialFirstName: | JORGE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7873667726 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0204X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Emergency Medicine |
No ID Information.