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General NPI Number Information
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NPI Number | 1417286113
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Entity Type | Organization
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Legal Business Name | GRUPO FISIATRICO CAROLINA, PSC. PHYSIATRIC SERVICES
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Dates
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Enumeration Date | 12/09/2009
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Last Update Date | 12/09/2009
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Provider Practice Location Address
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Address Line | AVE. MONSERRATE BH-11 VALLE ARRIBA HEIGHTS
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City | CAROLINA
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State | PR
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Zip | 00983
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Country | US
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Telephone | 787-762-1319
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Fax | 787-276-4620
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Provider Business Mailing Address
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Address Line | P.O. BOX 4217
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City | CAROLINA
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State | PR
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Zip | 00984-4217
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Country | US
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Telephone | 787-762-1319
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Fax | 787-276-4620
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. LUIS A. SOTO
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Credential | M.D.
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Telephone | 787-762-1319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 12562
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 10403
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License Number State | PR
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