Healthcare Provider Details

I. General information

NPI: 1679891071
Provider Name (Legal Business Name): KBAUCAGE FISIATRA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2010
Last Update Date: 05/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SEVERIANO CUEVAS # 18 HOSPITAL BUEN SAMARITANO
AGUADILLA PR
00603-5500
US

IV. Provider business mailing address

PO BOX 9
AGUADILLA PR
00605-0009
US

V. Phone/Fax

Practice location:
  • Phone: 787-891-4833
  • Fax: 787-882-5405
Mailing address:
  • Phone: 787-819-5900
  • Fax: 787-882-5405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHIA S BAUCAGE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-819-5900