Provider Demographics
NPI:1699814657
Name:GRUPO FISIATRICO HERNANDEZ DE LA FUENTE CSP
Entity Type:Organization
Organization Name:GRUPO FISIATRICO HERNANDEZ DE LA FUENTE CSP
Other - Org Name:CARIBEAN INSTITUTE OF SPORTS MEDICINE AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-277-0871
Mailing Address - Street 1:100 CARR 165 STE 303
Mailing Address - Street 2:CENTRO INTERNACIONAL DE MERCADEO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-8049
Mailing Address - Country:US
Mailing Address - Phone:787-277-0871
Mailing Address - Fax:787-277-0942
Practice Address - Street 1:100 CARR 165 STE 303
Practice Address - Street 2:CENTRO INTERNACIONAL DE MERCADEO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-8049
Practice Address - Country:US
Practice Address - Phone:787-277-0871
Practice Address - Fax:787-277-0942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14361225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty