Healthcare Provider Details

I. General information

NPI: 1528309804
Provider Name (Legal Business Name): PRSPI, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2013
Last Update Date: 03/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 AVE ANDALUCIA URB. PUERTO NUEVO
SAN JUAN PR
00920-5311
US

IV. Provider business mailing address

2312 CALLE TENIENTE RIVERA URB. SANTA TERESITA
SAN JUAN PR
00913-4530
US

V. Phone/Fax

Practice location:
  • Phone: 787-461-1780
  • Fax:
Mailing address:
  • Phone: 787-461-1780
  • Fax: 787-727-4887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number15364
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number15364
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number15364
License Number StatePR

VIII. Authorized Official

Name: LUIS BAERGA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-461-1780