Provider Demographics
NPI:1710689856
Name:HEALING WATERS CENTRO PARA EL MANEJO DEL DOLOR Y SALUD FAMILIAR
Entity Type:Organization
Organization Name:HEALING WATERS CENTRO PARA EL MANEJO DEL DOLOR Y SALUD FAMILIAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HIRAM
Authorized Official - Middle Name:EFRAIN
Authorized Official - Last Name:ISAAC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:939-465-1196
Mailing Address - Street 1:54 CALLE CELIS AGUILERA N
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-4811
Mailing Address - Country:US
Mailing Address - Phone:939-465-1196
Mailing Address - Fax:
Practice Address - Street 1:54 CALLE CELIS AGUILERA N
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-4811
Practice Address - Country:US
Practice Address - Phone:939-465-1196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2023-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty