Healthcare Provider Details

I. General information

NPI: 1821488644
Provider Name (Legal Business Name): CARIBBEAN INTERVENTIONAL PAIN MANAGEMENT SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2015
Last Update Date: 02/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 AVE DOMENECH
SAN JUAN PR
00918-3708
US

IV. Provider business mailing address

35 CALLE JUAN C BORBON STE 67-333
GUAYNABO PR
00969-5374
US

V. Phone/Fax

Practice location:
  • Phone: 787-675-0050
  • Fax: 888-664-2337
Mailing address:
  • Phone: 787-429-4369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number12003
License Number StatePR

VIII. Authorized Official

Name: ANTONIO KRAEMER
Title or Position: CENTER MANAGER
Credential: B. SC.
Phone: 787-429-4369