Provider Demographics
NPI:1619030202
Name:GRUPO PEDIATRICO DE LA MONTANA C.S.P.
Entity type:Organization
Organization Name:GRUPO PEDIATRICO DE LA MONTANA C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXIMINO
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-869-2575
Mailing Address - Street 1:PO BOX 314
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-0314
Mailing Address - Country:US
Mailing Address - Phone:787-869-2575
Mailing Address - Fax:787-869-2575
Practice Address - Street 1:61 CALLE GEORGETTI
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-3027
Practice Address - Country:US
Practice Address - Phone:787-869-2575
Practice Address - Fax:787-869-2575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherID TAX