Provider Demographics
NPI:1538570114
Name:PEDIATRIC ENDOCRINOLOGY SERVICES
Entity type:Organization
Organization Name:PEDIATRIC ENDOCRINOLOGY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:WISCOVITCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-502-2598
Mailing Address - Street 1:13 CAMINO LOS BAEZ APT 802
Mailing Address - Street 2:CAMINO LOS BAEZ
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971-9636
Mailing Address - Country:US
Mailing Address - Phone:787-502-2598
Mailing Address - Fax:
Practice Address - Street 1:BOSQUE MAR APT.302-A
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-502-2598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9670174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty