Provider Demographics
NPI:1730238429
Name:ASHFORD PEDIATRIC GROUP PARTNERSHIP
Entity type:Organization
Organization Name:ASHFORD PEDIATRIC GROUP PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DE JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-725-1118
Mailing Address - Street 1:29 CALLE WASHINGTON
Mailing Address - Street 2:SUITE 108-B ASHFORD MEDICAL CENTER
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1510
Mailing Address - Country:US
Mailing Address - Phone:787-725-1118
Mailing Address - Fax:787-725-0909
Practice Address - Street 1:29 CALLE WASHINGTON
Practice Address - Street 2:SUITE 108-B ASHFORD MEDICAL CENTER
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1510
Practice Address - Country:US
Practice Address - Phone:787-725-1118
Practice Address - Fax:787-725-0909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty