=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114343555
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARIBBEAN MUSCULOSKELETAL AND REHAB LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2014
-----------------------------------------------------
Last Update Date | 05/08/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | STREET #2, KM 142.2
-----------------------------------------------------
City | ANASCO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-951-2258
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2621
-----------------------------------------------------
City | MAYAGUEZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00681-2621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-951-2258
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. AMOGH SAHAI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 787-951-2258
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | 18098
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------