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General NPI Number Information
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NPI Number | 1659749166
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Entity Type | Organization
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Legal Business Name | CENTRO INTEGRAL DE REHABILITACION Y TERAPIAS LLC
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Dates
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Enumeration Date | 09/14/2015
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Last Update Date | 01/24/2024
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Provider Practice Location Address
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Address Line | HC 4 BOX 9340
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City | UTUADO
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State | PR
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Zip | 00641-7722
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Country | US
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Telephone | 939-274-0837
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Fax |
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Provider Business Mailing Address
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Address Line | HC 4 BOX 9340
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City | UTUADO
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State | PR
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Zip | 00641-7722
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Country | US
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Telephone | 787-391-8024
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED PERSON
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Name | JOSE JAVIER DIAZ VAZQUEZ
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Credential |
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Telephone | 939-274-0837
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number | 4519
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License Number State | PR
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