Provider Demographics
NPI:1710245923
Name:REHABILITACION DORADA, INC
Entity Type:Organization
Organization Name:REHABILITACION DORADA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPT- PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:XANDRA
Authorized Official - Middle Name:N
Authorized Official - Last Name:ZAYAS-CRESPO
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:939-630-2569
Mailing Address - Street 1:URB GRAN VISTA 1 CAMINO DEL PLATA
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:939-630-2569
Mailing Address - Fax:787-870-6706
Practice Address - Street 1:URB GRAN VISTA 1 CAMINO DEL PLATA
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:939-630-2569
Practice Address - Fax:787-870-6706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1375225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038231100Medicaid
PR1508061037OtherINDIVIDUAL NPI
PR1375OtherSTATE LICENCE