1225196496 NPI number — REHABILITACION Y MEDICINA DEPORTIVA INC

Table of content: (NPI 1225196496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225196496 NPI number — REHABILITACION Y MEDICINA DEPORTIVA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REHABILITACION Y MEDICINA DEPORTIVA 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:
MICHAEL HERNANDEZ MD
Provider Other Organization Name Type Code:
5
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:
1225196496
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2500
Provider Second Line Business Mailing Address:
PMB 122
Provider Business Mailing Address City Name:
TRUJILLO ALTO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00977-2500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-276-7006
Provider Business Mailing Address Fax Number:
787-276-7030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE FRAGOJO #4ES12
Provider Second Line Business Practice Location Address:
VILLA FONTANA
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00983
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-276-7006
Provider Business Practice Location Address Fax Number:
787-276-7030
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HERNANDEZ
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
MD PARTNER VICE PRESIDENT
Authorized Official Telephone Number:
787-276-7006

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  14361 , 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)

  • Identifier: A 391 . This is a "INTERNATIONAL MEDICAL CO" identifier . This identifiers is of the category "OTHER".




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