Healthcare Provider Details

I. General information

NPI: 1659192250
Provider Name (Legal Business Name): CARIBBEAN INTERVENTIONAL SPINE INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1395 CALLE SAN RAFAEL
SAN JUAN PR
00909-2518
US

IV. Provider business mailing address

1395 CALLE SAN RAFAEL
SAN JUAN PR
00909-2518
US

V. Phone/Fax

Practice location:
  • Phone: 787-941-2756
  • Fax:
Mailing address:
  • Phone: 787-941-2756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JORGE A CACERES
Title or Position: PAIN MEDICINE PHYSICIAN
Credential: MD
Phone: 939-218-0172