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General NPI Number Information
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NPI Number | 1053082891
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Entity Type | Organization
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Legal Business Name | CLINICA REUVIVA
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Dates
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Enumeration Date | 09/22/2021
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 1 AVE ALBOLOTE STE 201
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City | GUAYNABO
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State | PR
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Zip | 00969-2807
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Country | US
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Telephone | 939-945-8335
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Fax |
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Provider Business Mailing Address
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Address Line | 55 CALLE CASALS
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City | GUAYNABO
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State | PR
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Zip | 00969-1004
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Country | US
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Telephone | 939-945-8335
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Fax |
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Authorized Official
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Title or Position | ADMINISTRADORA
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Name | MS. ISIS M VAZQUEZ-OTERO
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Credential |
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Telephone | 939-945-8335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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