1548475981 NPI number — INSTITUTO DE FISIATRIA Y MEDICINA DEPORTIVA DEL ESTE, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548475981 NPI number — INSTITUTO DE FISIATRIA Y MEDICINA DEPORTIVA DEL ESTE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSTITUTO DE FISIATRIA Y MEDICINA DEPORTIVA DEL ESTE, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

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 Information

NPI Number:
1548475981
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1933
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JUNCOS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00777-1933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-734-4305
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 CALLE ALMODOVAR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JUNCOS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00777-3303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-734-4305
Provider Business Practice Location Address Fax Number:
787-713-4444
Provider Enumeration Date:
05/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MARQUEZ
Authorized Official First Name:
BEVERLY
Authorized Official Middle Name:
ARROYO
Authorized Official Title or Position:
PHYSIATRIST
Authorized Official Telephone Number:
787-209-0696

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X , with the licence number:  13591 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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