Healthcare Provider Details

I. General information

NPI: 1790077444
Provider Name (Legal Business Name): JUVENTUD REHAB CSP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 693 KM 14.2 BO. BRENAS
VEGA ALTA PR
00692
US

IV. Provider business mailing address

PO BOX 468
VEGA BAJA PR
00694-0468
US

V. Phone/Fax

Practice location:
  • Phone: 787-270-2686
  • Fax: 787-270-5292
Mailing address:
  • Phone: 787-270-2686
  • Fax: 787-270-5292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number001043
License Number StatePR

VIII. Authorized Official

Name: MISS BRENDA L. DE JESUS
Title or Position: PRESIDENTE
Credential: P.T.
Phone: 787-270-2686