Healthcare Provider Details

I. General information

NPI: 1457627408
Provider Name (Legal Business Name): CENTRO QUIROPRACTICO DE LAS CATALINAS CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2012
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LAS CATALINAS MALL CINEMAS BLDG. SUITE 210
CAGUAS PR
00725-5200
US

IV. Provider business mailing address

LAS CATALINAS MALL 600 CALLE BETANCES
CAGUAS PR
00727
US

V. Phone/Fax

Practice location:
  • Phone: 787-703-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number397
License Number StatePR

VIII. Authorized Official

Name: FEDERICO OSUNA PEREZ
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 787-703-3000