Basic Information
| Provider Information | |||||||||
| NPI: | 1295227338 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAFARI PEDIATRIC CLINIC, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1507 | ||||||||
| Address2: | |||||||||
| City: | MANATI | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006741507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876472873 | ||||||||
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| Practice Location | |||||||||
| Address1: | CARR #2 KM 43.3 BO ALGARROBOS | ||||||||
| Address2: | |||||||||
| City: | VEGA BAJA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876549532 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2018 | ||||||||
| LastUpdateDate: | 07/27/2021 | ||||||||
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| AuthorizedOfficialLastName: | RAMOS | ||||||||
| AuthorizedOfficialFirstName: | REBECCA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7876549532 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 07/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133VN1004X | N | 193200000X MULTI-SPECIALTY GROUP | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Pediatric | 208000000X | 18147 | PR | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.