Healthcare Provider Details

I. General information

NPI: 1013009984
Provider Name (Legal Business Name): CENTRO DE REHABILITACION Y ELECTRODIAGNOSTICO DE HATO REY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 PONCE DE LEON EDIFICIO METROPOLIS SUITE 102
SAN JUAN PR
00917-3403
US

IV. Provider business mailing address

419 PONCE DE LEON EDIFICIO METROPOLIS SUITE 102
SAN JUAN PR
00917-3403
US

V. Phone/Fax

Practice location:
  • Phone: 787-754-0725
  • Fax: 787-622-3490
Mailing address:
  • Phone: 787-754-0725
  • Fax: 787-622-3490

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 Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number9491
License Number StatePR

VIII. Authorized Official

Name: DR. MIGUEL P CARDONA
Title or Position: OWNER
Credential: M.D.
Phone: 787-754-0725