Provider Demographics
NPI:1568140911
Name:MEDICOLEGAL PHYSIATRIST SERVICES PSC
Entity Type:Organization
Organization Name:MEDICOLEGAL PHYSIATRIST SERVICES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWN
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:CORTES SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-672-2264
Mailing Address - Street 1:HACIENDA SAN JOSE
Mailing Address - Street 2:1450 PUERTA DEL PARQUE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-1383
Mailing Address - Country:US
Mailing Address - Phone:787-672-2264
Mailing Address - Fax:
Practice Address - Street 1:SUITE E
Practice Address - Street 2:CENTRO COMERCIAL LOS PRADOS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727
Practice Address - Country:US
Practice Address - Phone:787-961-0091
Practice Address - Fax:787-961-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-06
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty