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General NPI Number Information
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NPI Number | 1518175322
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Entity Type | Organization
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Legal Business Name | GRUPO FISIATRICO VILLA CARMEN, CSP
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 05/02/2012
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Provider Practice Location Address
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Address Line | BAYAMON K 13 VILLA CARMEN
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-743-8730
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Fax | 787-745-6133
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Provider Business Mailing Address
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Address Line | PO BOX 9328
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City | CAGUAS
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State | PR
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Zip | 00726-9328
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Country | US
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Telephone | 787-743-8730
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Fax | 787-745-6133
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Authorized Official
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Title or Position | OWNER
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Name | DR. LIMARY RIOS CAMACHO
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Credential |
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Telephone | 787-743-8730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 12556
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License Number State | PR
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