Provider Demographics
NPI:1174566236
Name:CENTRO DE PEDIATRIA Y MEDICINA DE FAMILIA DE VILLALBA, CSP
Entity type:Organization
Organization Name:CENTRO DE PEDIATRIA Y MEDICINA DE FAMILIA DE VILLALBA, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:A
Authorized Official - Last Name:PEREZ AYBAR
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:787-847-4667
Mailing Address - Street 1:PO BOX 6004
Mailing Address - Street 2:MSC 247
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-6004
Mailing Address - Country:US
Mailing Address - Phone:787-847-4667
Mailing Address - Fax:787-847-4868
Practice Address - Street 1:BO TIERRA SANTA
Practice Address - Street 2:KM 58.2 CARR 149
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766
Practice Address - Country:US
Practice Address - Phone:787-847-4667
Practice Address - Fax:787-847-4868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR008564208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0085049Medicare ID - Type Unspecified