Healthcare Provider Details

I. General information

NPI: 1184613002
Provider Name (Legal Business Name): GRUPO FISIATRICO TORRE AUXILIO MUTUO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CONDOMINIO TORRE AUXILIO MUTUO 735 AVE PONCE DE LEON, STE 417
SAN JUAN PR
00917
US

IV. Provider business mailing address

CONDOMINIO TORRE AUXILIO MUTUO 735 AVE PONCE DE LEON, STE 417
SAN JUAN PR
00917
US

V. Phone/Fax

Practice location:
  • Phone: 787-296-3081
  • Fax:
Mailing address:
  • Phone: 787-296-3081
  • Fax:

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 E ARIAS BENABE
Title or Position: FISIATRA
Credential: M.D.
Phone: 787-296-3081