Provider Demographics
NPI:1861769556
Name:DOCTOR KIDS CENTER P.S.C.
Entity type:Organization
Organization Name:DOCTOR KIDS CENTER P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENLIZ
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROBLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-718-3449
Mailing Address - Street 1:PO BOX 801293
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-1293
Mailing Address - Country:US
Mailing Address - Phone:787-848-5600
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA LAS AMERICAS
Practice Address - Street 2:PISO # 1 HOSPITAL METROPOLITANO DR. PILA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-848-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13375261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center