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General NPI Number Information
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NPI Number | 1497338008
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Entity Type | Organization
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Legal Business Name | CLINICA DE FISIATRIA NEUROMUSCULAR DE PONCE, C.S.P.
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Dates
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Enumeration Date | 04/30/2021
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Last Update Date | 05/13/2021
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Provider Practice Location Address
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Address Line | 310 TORRE SAN CRISTOBAL
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City | COTO LAUREL
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State | PR
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Zip | 00780-2856
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Country | US
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Telephone | 787-840-2747
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Fax | 787-651-3847
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Provider Business Mailing Address
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Address Line | PO BOX 800997
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City | COTO LAUREL
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State | PR
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Zip | 00780-0997
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Country | US
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Telephone | 787-840-2747
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Fax | 787-651-3847
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELBA YESI GERENA MALDONADO
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Credential | MD
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Telephone | 787-840-2747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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