Provider Demographics
NPI:1497338008
Name:CLINICA DE FISIATRIA NEUROMUSCULAR DE PONCE, C.S.P.
Entity Type:Organization
Organization Name:CLINICA DE FISIATRIA NEUROMUSCULAR DE PONCE, C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELBA
Authorized Official - Middle Name:YESI
Authorized Official - Last Name:GERENA MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-840-2747
Mailing Address - Street 1:PO BOX 800997
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-0997
Mailing Address - Country:US
Mailing Address - Phone:787-840-2747
Mailing Address - Fax:787-651-3847
Practice Address - Street 1:310 TORRE SAN CRISTOBAL
Practice Address - Street 2:
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780-2856
Practice Address - Country:US
Practice Address - Phone:787-840-2747
Practice Address - Fax:787-651-3847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-30
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty