Provider Demographics
NPI:1326086232
Name:CLINICA DE MANEJO DEL DOLOR DR CRAWFORD W LONG C S P
Entity Type:Organization
Organization Name:CLINICA DE MANEJO DEL DOLOR DR CRAWFORD W LONG C S P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:IBARRA
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-735-8900
Mailing Address - Street 1:PO BOX 1869
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-1869
Mailing Address - Country:US
Mailing Address - Phone:787-735-8900
Mailing Address - Fax:787-735-3040
Practice Address - Street 1:204 CALLE JULIO CINTRON
Practice Address - Street 2:EDIFICIO GUAYACAN SUITE 224
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-735-8900
Practice Address - Fax:787-735-3040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7701207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0082070OtherPETAN
PR0082070OtherPETAN
PR10382Medicare ID - Type Unspecified