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General NPI Number Information
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NPI Number | 1942629670
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Entity Type | Organization
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Legal Business Name | CENTRO DE EVALUACION Y TERAPIA DE PENUELAS INC
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Dates
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Enumeration Date | 04/09/2014
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Last Update Date | 04/09/2014
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Provider Practice Location Address
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Address Line | 710 CALLE AMALIA MARIN
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City | PENUELAS
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State | PR
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Zip | 00624-1719
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Country | US
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Telephone | 787-836-5549
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Fax | 787-836-5549
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Provider Business Mailing Address
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Address Line | 710 CALLE AMALIA MARIN
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City | PENUELAS
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State | PR
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Zip | 00624-1719
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Country | US
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Telephone | 787-836-5549
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Fax | 787-836-5549
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ANGEL LUIS PACHECO
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Credential |
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Telephone | 787-836-5549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 305962
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License Number State | PR
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