Provider Demographics
NPI:1174777551
Name:SECCION ANINOS CON NECESIDADES ESPECIALES DE SALUD
Entity type:Organization
Organization Name:SECCION ANINOS CON NECESIDADES ESPECIALES DE SALUD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTORA
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:787-771-2100
Mailing Address - Street 1:410 AVE HOSTOS, SUITE #1
Mailing Address - Street 2:CENTRO PEDIATRICO DE MAYAGUEZ VACUNACION
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-1522
Mailing Address - Country:US
Mailing Address - Phone:787-833-3100
Mailing Address - Fax:787-832-6015
Practice Address - Street 1:410 AVE HOSTOS, SUITE #1
Practice Address - Street 2:CENTRO PEDIATRICO DE MAYAGUEZ VACUNACION
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1522
Practice Address - Country:US
Practice Address - Phone:787-832-3100
Practice Address - Fax:787-832-6015
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRO DE VACUNACION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC017OtherPEDIATRA
PRS018OtherOFTALMOLOGIA
PR120537OtherMED Y ALIADOS
PR88755OtherMED
PRS020OtherOETOPEDIA
PRS022OtherAUDIOLOGIA
PR81394OtherALIADOS
PRP0051OtherAUDILOGIA
PRP5174OtherPSICOLOGA
PRP6044OtherPATOLOGA DEL HABLA
PRS019OtherCIRUJANO
PR00433CPMOtherMED Y ALIADOS
PR203699OtherMED Y ALIADOS
PR6800103OtherMED Y ALIADOS
PR660433481-2OtherMED