Healthcare Provider Details

I. General information

NPI: 1326086232
Provider Name (Legal Business Name): CLINICA DE MANEJO DEL DOLOR DR CRAWFORD W LONG C S P
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 CALLE JULIO CINTRON EDIFICIO GUAYACAN SUITE 224
AIBONITO PR
00705
US

IV. Provider business mailing address

PO BOX 1869
AIBONITO PR
00705-1869
US

V. Phone/Fax

Practice location:
  • Phone: 787-735-8900
  • Fax: 787-735-3040
Mailing address:
  • Phone: 787-735-8900
  • Fax: 787-735-3040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number7701
License Number StatePR

VIII. Authorized Official

Name: DR. EDUARDO IBARRA ORTEGA
Title or Position: PRESIDENTE
Credential: M.D.
Phone: 787-735-8900