Provider Demographics
NPI:1750680344
Name:CENTRO RETO DE LA MONTANA INC
Entity Type:Organization
Organization Name:CENTRO RETO DE LA MONTANA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:G
Authorized Official - Last Name:LEON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:787-923-0203
Mailing Address - Street 1:PMB 169 BOX 2400
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-2400
Mailing Address - Country:US
Mailing Address - Phone:787-954-7770
Mailing Address - Fax:787-954-7771
Practice Address - Street 1:CALLE JULIO CINTRON #202
Practice Address - Street 2:EDIFICIO GUAYACAN SUITE 218
Practice Address - City:AIBONTIO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-633-5291
Practice Address - Fax:787-735-7613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-22
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR402225100000X
225X00000X, 235Z00000X
PR1056225X00000X
PR946235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
946OtherLICENCIA