Basic Information
| Provider Information | |||||||||
| NPI: | 1295907228 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMPEDS PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1357 ASHFORD AVE | ||||||||
| Address2: | PMB 427 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7875259700 | ||||||||
| FaxNumber: | 7879778008 | ||||||||
| Practice Location | |||||||||
| Address1: | HOSPITAL WILMA VAZQUEZ | ||||||||
| Address2: | DEPARTAMENTO DE PEDIATRIA | ||||||||
| City: | VEGA BAJA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878581580 | ||||||||
| FaxNumber: | 7879778008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2008 | ||||||||
| LastUpdateDate: | 07/28/2011 | ||||||||
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| AuthorizedOfficialLastName: | REYES SEDA | ||||||||
| AuthorizedOfficialFirstName: | AITZA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7875259700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 13281 | PR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 13281 | 01 | PR | LIC | OTHER |