Provider Demographics
NPI:1659749166
Name:CENTRO INTEGRAL DE REHABILITACION Y TERAPIAS LLC
Entity Type:Organization
Organization Name:CENTRO INTEGRAL DE REHABILITACION Y TERAPIAS LLC
Other - Org Name:NONE
Other - Org Type:Other Name
Authorized Official - Title/Position:AUTHORIZED PERSON
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:DIAZ VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:939-274-0837
Mailing Address - Street 1:HC 4 BOX 9340
Mailing Address - Street 2:
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641-7722
Mailing Address - Country:US
Mailing Address - Phone:787-391-8024
Mailing Address - Fax:
Practice Address - Street 1:HC 4 BOX 9340
Practice Address - Street 2:
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641-7722
Practice Address - Country:US
Practice Address - Phone:939-274-0837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4519261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)