Provider Demographics
NPI:1821488644
Name:CARIBBEAN INTERVENTIONAL PAIN MANAGEMENT SURGICAL CENTER
Entity Type:Organization
Organization Name:CARIBBEAN INTERVENTIONAL PAIN MANAGEMENT SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CENTER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAEMER
Authorized Official - Suffix:
Authorized Official - Credentials:B SC
Authorized Official - Phone:787-429-4369
Mailing Address - Street 1:35 CALLE JUAN C BORBON STE 67-333
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5374
Mailing Address - Country:US
Mailing Address - Phone:787-429-4369
Mailing Address - Fax:
Practice Address - Street 1:365 AVE DOMENECH
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3708
Practice Address - Country:US
Practice Address - Phone:787-675-0050
Practice Address - Fax:888-664-2337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-01
Last Update Date:2015-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12003261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain