Premium Pediatric Group

Primary specialty

Personal Emergency Response AttendantTaxonomy code 146D00000X

License

12804 Issued in PR

Legal business name

PREMIUM PEDIATRIC GROUP

Practice address

Calle 129 Ave San Luis
129
Arecibo, PR 00614-0000

Phone

(787) 955-9130

NPI assigned

Apr 29, 2016

Last updated

Apr 29, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Luis Cruz

Title

Administrador

Phone

(787) 955-9130

Specialties & licenses 1

Addresses

Other names 1

• PREMIUM PEDIATRIC GROUP PSC Former legal business name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1461888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461888000000",
    "number": "1962857631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "439 GUANICA",
            "address_2": "URB SABANERA",
            "city": "DORADO",
            "state": "PR",
            "postal_code": "006460000",
            "telephone_number": "787-955-9130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CALLE 129 AVE SAN LUIS",
            "address_2": "129",
            "city": "ARECIBO",
            "state": "PR",
            "postal_code": "006140000",
            "telephone_number": "787-955-9130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIUM PEDIATRIC GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-29",
        "last_updated": "2016-04-29",
        "status": "A",
        "authorized_official_last_name": "CRUZ",
        "authorized_official_first_name": "LUIS",
        "authorized_official_title_or_position": "ADMINISTRADOR",
        "authorized_official_telephone_number": "787-955-9130"
    },
    "taxonomies": [
        {
            "code": "146D00000X",
            "taxonomy_group": "",
            "desc": "Personal Emergency Response Attendant",
            "state": "PR",
            "license": "12804",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PREMIUM PEDIATRIC GROUP PSC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Rafael A Portela Gonzalez, D.M.D.
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• Personal Emergency Response Attendant in Arecibo, PR
• Providers in Arecibo, PR by specialty
• Personal Emergency Response Attendant in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.