Provider Demographics
NPI:1760896609
Name:CENTRO REUMATOLOGICO DE CAGUAS
Entity Type:Organization
Organization Name:CENTRO REUMATOLOGICO DE CAGUAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMARILIS
Authorized Official - Middle Name:JANETTE
Authorized Official - Last Name:PEREZ-DE JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-286-8465
Mailing Address - Street 1:M36 CALLE 13
Mailing Address - Street 2:CONDADO MODERNO
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-2443
Mailing Address - Country:US
Mailing Address - Phone:787-286-8465
Mailing Address - Fax:
Practice Address - Street 1:M36 CALLE 13
Practice Address - Street 2:CONDADO MODERNO
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-2443
Practice Address - Country:US
Practice Address - Phone:787-286-8465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10231261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty