Provider Demographics
NPI:1568136695
Name:TERAPIAS INTERDISCIPLINARIAS DE EXCELENCIA EN SERVICIO CORP.
Entity Type:Organization
Organization Name:TERAPIAS INTERDISCIPLINARIAS DE EXCELENCIA EN SERVICIO CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIRMARYS
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINONES - IRIZARRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-203-2186
Mailing Address - Street 1:HC 1 BOX 3787
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-9611
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CARR 111 KM 1.2 BO PUEBLO INT 436
Practice Address - Street 2:AVE LOS PATRIOTAS
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669
Practice Address - Country:US
Practice Address - Phone:787-203-2186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center