Healthcare Provider Details

I. General information

NPI: 1982472700
Provider Name (Legal Business Name): RFN-IPSRM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2023
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 AVE ANDALUCIA
SAN JUAN PR
00920-5311
US

IV. Provider business mailing address

PO BOX 1603
DORADO PR
00646-1603
US

V. Phone/Fax

Practice location:
  • Phone: 787-408-6239
  • Fax:
Mailing address:
  • Phone: 787-408-6239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD ALEXANDER FONTANEZ NIEVES
Title or Position: PRESIDENT
Credential: MD
Phone: 787-408-6239