Basic Information
| Provider Information | |||||||||
| NPI: | 1417035585 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SERVICIOS REHABILITACION DEL NORTE, CSP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4215 | ||||||||
| Address2: | |||||||||
| City: | VEGA BAJA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006944215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878558624 | ||||||||
| FaxNumber: | 7876501030 | ||||||||
| Practice Location | |||||||||
| Address1: | CALLE PALMER 55 - HOSPITAL DR. SUSONI | ||||||||
| Address2: | |||||||||
| City: | ARECIBO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876501030 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 06/21/2013 | ||||||||
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| AuthorizedOfficialLastName: | MARRERO | ||||||||
| AuthorizedOfficialFirstName: | JAIME | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7878558624 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.