Provider Demographics
NPI:1710169917
Name:CENTRO FISIATRICO Y REHABILITACION
Entity Type:Organization
Organization Name:CENTRO FISIATRICO Y REHABILITACION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTA
Authorized Official - Prefix:
Authorized Official - First Name:LISSETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ACOSTA RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-453-0050
Mailing Address - Street 1:PO BOX 20897
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-0897
Mailing Address - Country:US
Mailing Address - Phone:787-757-3939
Mailing Address - Fax:
Practice Address - Street 1:CAROLINA SHOPP CTR
Practice Address - Street 2:LOCAL 26A
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-5672
Practice Address - Country:US
Practice Address - Phone:787-757-3939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
H42300Medicare UPIN