Provider Demographics
NPI:1093258113
Name:CARIBBEAN FOOT CLINIC, LLC.
Entity Type:Organization
Organization Name:CARIBBEAN FOOT CLINIC, LLC.
Other - Org Name:JOSE C RODRIGUEZ PORTELA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:C
Authorized Official - Last Name:RODRIGUEZ PORTELA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:787-344-3553
Mailing Address - Street 1:PO BOX 1886
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-1886
Mailing Address - Country:US
Mailing Address - Phone:787-270-1333
Mailing Address - Fax:787-270-1330
Practice Address - Street 1:1 MARGINAL URB SANTA RITA
Practice Address - Street 2:CARIBE MEDICAL PLAZA SUITE 201
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-270-1333
Practice Address - Fax:787-270-1330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR103261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1427142645Medicare UPIN