Provider Demographics
NPI:1790077444
Name:JUVENTUD REHAB CSP.
Entity Type:Organization
Organization Name:JUVENTUD REHAB CSP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DE JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:787-270-2686
Mailing Address - Street 1:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-0468
Mailing Address - Country:US
Mailing Address - Phone:787-270-2686
Mailing Address - Fax:787-270-5292
Practice Address - Street 1:CARRETERA 693 KM 14.2
Practice Address - Street 2:BO. BRENAS
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-270-2686
Practice Address - Fax:787-270-5292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001043261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy