Provider Demographics
NPI:1972044642
Name:WORKOUT FITNESS
Entity Type:Organization
Organization Name:WORKOUT FITNESS
Other - Org Name:WORKOUT HEALTH CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-671-3132
Mailing Address - Street 1:572 CALLE CESAR GONZALEZ
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3738
Mailing Address - Country:US
Mailing Address - Phone:787-751-2944
Mailing Address - Fax:
Practice Address - Street 1:572 CALLE CESAR GONZALEZ
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3738
Practice Address - Country:US
Practice Address - Phone:787-751-2944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0623261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========9Medicaid