Organization
PREMIUM PEDIATRIC GROUP
Active
Other names
PREMIUM PEDIATRIC GROUP PSC
Organization subpart
No
Provider details
NPI number
Authorized official
LUIS CRUZ (ADMINISTRADOR)
(787) 955-9130
Entity
Organization
Contact information
Practice address
CALLE 129 AVE SAN LUIS, 129, ARECIBO, PR 00614-0000
(787) 955-9130
Mailing address
439 GUANICA, URB SABANERA, DORADO, PR 00646-0000
(787) 955-9130
Taxonomy
Speciality
Code
Description
License number
State
146D00000X
Personal Emergency Response Attendant
Primary
12804
PR
Other
Enumeration date
04/29/2016
Last updated
04/29/2016
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