Provider Demographics
NPI:1164607966
Name:ELDA L. SANTIAGO PEREZ
Entity Type:Organization
Organization Name:ELDA L. SANTIAGO PEREZ
Other - Org Name:CENTRO DE REHABILITACION Y TERAPIA FISICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SANTIAGO-PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:787-854-1546
Mailing Address - Street 1:PO BOX 2191
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-2191
Mailing Address - Country:US
Mailing Address - Phone:787-854-1546
Mailing Address - Fax:787-633-1575
Practice Address - Street 1:CARR 670 KAROMA PLAZA
Practice Address - Street 2:SUITE #12
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-1546
Practice Address - Fax:787-633-1575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR367261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR84143SAMedicaid
PR84143Medicare PIN