Provider Demographics
NPI:1619358033
Name:GRUPO FISIATRICO CAROLINA LLC
Entity Type:Organization
Organization Name:GRUPO FISIATRICO CAROLINA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTA
Authorized Official - Prefix:
Authorized Official - First Name:MAITE
Authorized Official - Middle Name:URQUIA
Authorized Official - Last Name:ARAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-400-0102
Mailing Address - Street 1:5-3 CALLE 8
Mailing Address - Street 2:URB SABANA GARDENS
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983
Mailing Address - Country:US
Mailing Address - Phone:787-400-0102
Mailing Address - Fax:939-336-2485
Practice Address - Street 1:124 CALLE PLAZA SERENA
Practice Address - Street 2:URB ENTRERIOS
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-0000
Practice Address - Country:US
Practice Address - Phone:787-400-0102
Practice Address - Fax:939-336-2485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14221208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0021336Medicare UPIN