Healthcare Provider Details

I. General information

NPI: 1255133641
Provider Name (Legal Business Name): INES M BRULL RIOS DTP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 03/26/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 AVE MUNOZ RIVERA PASEO CARIBE BUILDING STE 104
SAN JUAN PR
00901-2480
US

IV. Provider business mailing address

1687 CALLE PORTUGUES URB RIO PIEDRAS HEIGHTS
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-330-2100
  • Fax: 787-289-8715
Mailing address:
  • Phone: 787-602-4660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4650
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: