Healthcare Provider Details

I. General information

NPI: 1538543038
Provider Name (Legal Business Name): CENTRO DE SERVICIOS INDIVIDUALIZADOS ZURISADAI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 3 KM 20.8 CIENAGA BAJA
RIO GRANDE PR
00745
US

IV. Provider business mailing address

PO BOX 483
CANOVANAS PUERTO RICO
00729
UM

V. Phone/Fax

Practice location:
  • Phone: 787-342-5250
  • Fax:
Mailing address:
  • Phone: 787-342-5250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. LUIS COLON MARRERO
Title or Position: PRESIDENT
Credential:
Phone: 787-342-5250