Provider Demographics
NPI:1447438833
Name:PEDIATRIA NORTE CSP
Entity type:Organization
Organization Name:PEDIATRIA NORTE CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-884-4383
Mailing Address - Street 1:113 CALLE SALMON
Mailing Address - Street 2:NUEVAS ESTANCIAS
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-4943
Mailing Address - Country:US
Mailing Address - Phone:787-884-4383
Mailing Address - Fax:787-884-2331
Practice Address - Street 1:B-37 MARGINAL ELLIOT VELEZ
Practice Address - Street 2:URB. ATENAS
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4943
Practice Address - Country:US
Practice Address - Phone:787-884-4383
Practice Address - Fax:787-884-2331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12349174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty