Basic Information
| Provider Information | |||||||||
| NPI: | 1841313442 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRO DE REUMATOLOGIA PEDIATRICA DE PUERTO RICO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9066312 | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009066312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877261113 | ||||||||
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| Practice Location | |||||||||
| Address1: | 252 CALLE CONVENTO | ||||||||
| Address2: | |||||||||
| City: | SANTURCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009123207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877261113 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | QUINTERO DEL RIO | ||||||||
| AuthorizedOfficialFirstName: | ANA | ||||||||
| AuthorizedOfficialMiddleName: | I | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7877261113 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD, MPH | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0216X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Rheumatology |
No ID Information.