Provider Demographics
NPI:1417269408
Name:SERVICIOS FISIATRICOS DEL ESTE, PSC
Entity Type:Organization
Organization Name:SERVICIOS FISIATRICOS DEL ESTE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPIETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:LIDIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GARIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-860-1300
Mailing Address - Street 1:PMB 201 PO BOX 70005
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-7005
Mailing Address - Country:US
Mailing Address - Phone:787-860-1300
Mailing Address - Fax:787-863-8300
Practice Address - Street 1:375 GENERAL VALERO AVE.
Practice Address - Street 2:SUITE 101
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-860-1300
Practice Address - Fax:787-863-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8157261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherVETERANS ADMINISTRATION