Provider Demographics
NPI:1437263779
Name:CORPORACION LAS VEGAS INC
Entity Type:Organization
Organization Name:CORPORACION LAS VEGAS INC
Other - Org Name:CLINICA TERAPIA FISICA Y REHABILITACION DEL NORTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-854-1426
Mailing Address - Street 1:PO BOX 1086
Mailing Address - Street 2:RD #2, LAS VEGAS BLDG. #420, BO CAMPO ALEGRE KM 46.4
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1086
Mailing Address - Country:US
Mailing Address - Phone:787-854-1426
Mailing Address - Fax:787-854-1426
Practice Address - Street 1:ROAD NO. 2 KM 46.4
Practice Address - Street 2:EDIF LAS VEGAS #420, BO CAMPO ALEGRE
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-1086
Practice Address - Country:US
Practice Address - Phone:787-854-1426
Practice Address - Fax:787-854-1426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR#14261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR40-7014Medicare ID - Type Unspecified