Healthcare Provider Details

I. General information

NPI: 1720344815
Provider Name (Legal Business Name): CENTRO FISIATRICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 CARR #2 BAYAMON MEDICAL PLAZA SUITE 808
BAYAMON PUERTO RICO
00959
UM

IV. Provider business mailing address

PO BOX 506
BAYAMON PR
00960-0506
US

V. Phone/Fax

Practice location:
  • Phone: 787-785-4410
  • Fax: 787-785-4412
Mailing address:
  • Phone: 787-785-4410
  • Fax: 787-785-4412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number11055
License Number StatePR

VIII. Authorized Official

Name: DR. MARIA C COLON ROIG
Title or Position: OWNER/ ADMINISTRATOR
Credential: M.D.
Phone: 787-785-4410