=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225394687
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MRC PROPERTIES CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2012
-----------------------------------------------------
Last Update Date | 04/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 879 AVE MUNOZ RIVERA
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00925-2107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-638-8295
-----------------------------------------------------
Fax | 787-764-5962
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 800964
-----------------------------------------------------
City | COTO LAUREL
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00780-0964
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-638-8295
-----------------------------------------------------
Fax | 787-764-5962
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. MARITZA RIVERA
-----------------------------------------------------
Credential | LIC
-----------------------------------------------------
Telephone | 787-638-8295
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------