Basic Information
| Provider Information | |||||||||
| NPI: | 1649499294 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRO DE REHABILITACION Y MEDICINA DEL DEPORTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | CARIMED PLAZA | ||||||||
| Address2: | B1 CALLE SANTA CRUZ STE. 406 | ||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009616933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877796896 | ||||||||
| FaxNumber: | 7877857277 | ||||||||
| Practice Location | |||||||||
| Address1: | CARIMED PLAZA | ||||||||
| Address2: | B1 CALLE SANTA CRUZ STE. 406 | ||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009616933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877402270 | ||||||||
| FaxNumber: | 7877857277 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2007 | ||||||||
| LastUpdateDate: | 06/15/2011 | ||||||||
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| AuthorizedOfficialLastName: | ARIAS BENABE | ||||||||
| AuthorizedOfficialFirstName: | JOSE | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | GEN PTR | ||||||||
| AuthorizedOfficialTelephone: | 7877796896 | ||||||||
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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 | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.