Provider Demographics
NPI:1447226238
Name:CENTRO DE MEDICINA FISICA Y REHABILITACION RIO GRANDE,INC
Entity Type:Organization
Organization Name:CENTRO DE MEDICINA FISICA Y REHABILITACION RIO GRANDE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ISAMARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-887-2555
Mailing Address - Street 1:PO BOX 2884
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-2884
Mailing Address - Country:US
Mailing Address - Phone:787-887-2555
Mailing Address - Fax:787-657-5600
Practice Address - Street 1:B18 CALLE GARCIA DE LA NOCEDA
Practice Address - Street 2:VILLAS DE RIO GRANDE
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745-0000
Practice Address - Country:US
Practice Address - Phone:787-887-2555
Practice Address - Fax:787-657-5600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR85426OtherMEDICARE ID
PR=========OtherEIN