Provider Demographics
NPI:1164682456
Name:PHYSIATRIC AND EMERGENCY HEALTH SERVICES PSC
Entity Type:Organization
Organization Name:PHYSIATRIC AND EMERGENCY HEALTH SERVICES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MINETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-378-7698
Mailing Address - Street 1:PMB 478 1353
Mailing Address - Street 2:ROAD 19
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LAGUNA GARDENS SHOPPING CENTER
Practice Address - Street 2:SUITE 116 PRIMER NIVEL
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-367-3933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty