1366408403 NPI number — CARIBBEAN REHABILITATION SERVICES, PSC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366408403 NPI number — CARIBBEAN REHABILITATION SERVICES, PSC

Employer Identification Number (EIN):

Provider Organization Name:

CARIBBEAN REHABILITATION SERVICES, PSC

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

Provider Other Organization Name:

Provider Other Organization Name Type Code:

6

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1366408403

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

07/27/2015

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 11746

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SAN JUAN

Provider Business Mailing Address State Name:

PR

Provider Business Mailing Address Postal Code:

00910-2846

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

787-751-4551

Provider Business Mailing Address Fax Number:

787-751-4582

Provider First Line Business Practice Location Address:

PLAZA SAN FRANCISCO

Provider Second Line Business Practice Location Address:

201 AVE. DE DIEGO, SUITE 154

Provider Business Practice Location Address City Name:

SAN JUAN

Provider Business Practice Location Address State Name:

PR

Provider Business Practice Location Address Postal Code:

00927-5812

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

787-751-4551

Provider Business Practice Location Address Fax Number:

787-751-4582

Provider Enumeration Date:

04/26/2006

Authorized Official Last Name:

SEIN

Authorized Official First Name:

RAFAEL

Authorized Official Middle Name:

E

Authorized Official Title or Position:

PRESIDENT

Authorized Official Telephone Number:

787-751-4551

• Taxonomy code: 261QP2000X , with the licence number:  5935 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 261QR0400X , with the licence number: 5935 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 261QX0100X , with the licence number: 5935 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 065770 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 584221714 . This is a "HUMANA HEALTH PLAN OF PR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 2033 . This is a "INTERNATIONAL MEDICAL CAR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 52236 . This is a "FONDO DEL SEGURO DEL ESTA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 584221714 . This is a "CIGNA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 97542 . This is a "TRIPLE-S, INC." identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: 223050 . This is a "PREFERRED HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".