Provider Demographics
NPI:1225196496
Name:REHABILITACION Y MEDICINA DEPORTIVA INC
Entity Type:Organization
Organization Name:REHABILITACION Y MEDICINA DEPORTIVA INC
Other - Org Name:MICHAEL HERNANDEZ MD
Other - Org Type:Other Name
Authorized Official - Title/Position:MD PARTNER VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-276-7006
Mailing Address - Street 1:PO BOX 2500
Mailing Address - Street 2:PMB 122
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-2500
Mailing Address - Country:US
Mailing Address - Phone:787-276-7006
Mailing Address - Fax:787-276-7030
Practice Address - Street 1:AVE FRAGOJO #4ES12
Practice Address - Street 2:VILLA FONTANA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-276-7006
Practice Address - Fax:787-276-7030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14361225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A 391OtherINTERNATIONAL MEDICAL CO
H69543Medicare UPIN
84673Medicare ID - Type Unspecified