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General NPI Number Information
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NPI Number | 1629966007
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Entity Type | Organization
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Legal Business Name | CENTRO INDIVIDUAL DE MEDICINA ESPECIALIZADA LLC
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Dates
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Enumeration Date | 06/25/2025
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 140 AVE LAS CUMBRES
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City | GUAYNABO
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State | PR
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Zip | 00969-5523
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Country | US
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Telephone | 787-731-5785
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1475
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City | CAROLINA
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State | PR
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Zip | 00984-1475
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Country | US
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Telephone | 787-354-2514
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. AILED RIVERA SOTO
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Credential |
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Telephone | 787-354-2514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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