Provider Demographics
NPI:1417286113
Name:GRUPO FISIATRICO CAROLINA, PSC. PHYSIATRIC SERVICES
Entity Type:Organization
Organization Name:GRUPO FISIATRICO CAROLINA, PSC. PHYSIATRIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-762-1319
Mailing Address - Street 1:P.O. BOX 4217
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-4217
Mailing Address - Country:US
Mailing Address - Phone:787-762-1319
Mailing Address - Fax:787-276-4620
Practice Address - Street 1:AVE. MONSERRATE BH-11
Practice Address - Street 2:VALLE ARRIBA HEIGHTS
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-762-1319
Practice Address - Fax:787-276-4620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10403208100000X
PR12562208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty