Healthcare Provider Details

I. General information

NPI: 1679780753
Provider Name (Legal Business Name): CEFISAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GRAND BOULEVARD PASEOS GALERIA PASEOS MALL - SUITE 109
SAN JUAN PR
00926
US

IV. Provider business mailing address

100 GRAND BOULEVARD PASEOS SUITE 112-248
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-283-1554
  • Fax: 787-283-2776
Mailing address:
  • Phone: 787-283-1554
  • Fax: 787-283-2776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number929
License Number StatePR

VIII. Authorized Official

Name: MR. CARLOS JOSE RIVERA
Title or Position: PRESIDENT
Credential: RPT
Phone: 787-283-1554