=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225271828
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAPIDCLINICCSP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2009
-----------------------------------------------------
Last Update Date | 04/13/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 112 CALLE ARZUAGA STE 605
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00925-3316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-646-0202
-----------------------------------------------------
Fax | 787-763-0200
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | ARZUAGA 112 SUITE 605
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-646-0202
-----------------------------------------------------
Fax | 787-763-0200
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENTE
-----------------------------------------------------
Name | DR. PEREIRA ESTRADA OMAYRA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 787-646-0202
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 1862771
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 1862771
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------