Healthcare Provider Details

I. General information

NPI: 1841288198
Provider Name (Legal Business Name): GRUPO FISIATRICO DE COROZAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 CALLE BOU
COROZAL PR
00783-1949
US

IV. Provider business mailing address

PO BOX 2760
BAYAMON PR
00960-2760
US

V. Phone/Fax

Practice location:
  • Phone: 787-859-8726
  • Fax: 787-859-8724
Mailing address:
  • Phone: 787-859-8726
  • Fax: 787-859-8724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE EDUARDO ARIAS BENABE
Title or Position: FISIATRA
Credential: MD
Phone: 787-859-8726