Provider Demographics
NPI:1376947267
Name:CLINICA DE MEDICINA FISICA Y ELECTRODIAGNOSTICO INC.
Entity Type:Organization
Organization Name:CLINICA DE MEDICINA FISICA Y ELECTRODIAGNOSTICO INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:L
Authorized Official - Last Name:PEREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-385-8543
Mailing Address - Street 1:114 CALLE CENTRAL
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-8697
Mailing Address - Country:US
Mailing Address - Phone:787-891-4833
Mailing Address - Fax:787-882-5405
Practice Address - Street 1:RD#2 KM 133.5
Practice Address - Street 2:CENTERPLEX BLD SUITE 103
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-891-4833
Practice Address - Fax:787-882-5405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty