Provider Demographics
NPI:1891906434
Name:CENTRO FISIATRICO COUNTRY CLUB
Entity Type:Organization
Organization Name:CENTRO FISIATRICO COUNTRY CLUB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADORA
Authorized Official - Prefix:
Authorized Official - First Name:MAITE
Authorized Official - Middle Name:URQUIA
Authorized Official - Last Name:ARAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-276-3366
Mailing Address - Street 1:PB30 CALLE 266
Mailing Address - Street 2:EL COMANDANTE
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982-2767
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PB30 CALLE 266
Practice Address - Street 2:EL COMANDANTE
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982-2767
Practice Address - Country:US
Practice Address - Phone:787-276-3366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherNUMERO PATRONAL