Healthcare Provider Details

I. General information

NPI: 1528122694
Provider Name (Legal Business Name): CENTRO TERAPIA FISICA RIVERA NIEVES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 03/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ST. 693 BARRIO BRENAS SUITE NO 271
VEGA ALTA PR
00692
US

IV. Provider business mailing address

PO BOX 19
DORADO PR
00646-0019
US

V. Phone/Fax

Practice location:
  • Phone: 787-883-3939
  • Fax: 787-270-4933
Mailing address:
  • Phone: 787-883-3939
  • Fax: 787-270-4933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number1046
License Number StatePR

VIII. Authorized Official

Name: LILLIANA RIVERA NIEVES
Title or Position: OWNER FOR THERAPY CENTER
Credential: THERAPIST
Phone: 787-883-3939