MEDICARE: CENTRO DE EVALUACION E INTERVENCION PASOSM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician
2	2081P0010X	Pediatric Rehabilitation Medicine Physician

General Provider Information

NPI Number	:	1588998660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRO DE EVALUACION E INTERVENCION PASOSM

Provider Business Mailing Address
First Line	:	SAN JOVINO #421
Second Line	:	URB. SAGRADO CORAZON
City	:	SAN JUAN
State	:	PR
Zip	:	00926
Country	:	US
Telephone Number	:	787-747-1374
Fax Number	:	787-745-0549

Provider Business Practice Location Address
First Line	:	AVE. RAFAEL CORDERO FINAL, ESQ. TROCHE
Second Line	:	PLAZA DE SALUD SANOS
City	:	CAGUAS
State	:	PR
Zip	:	00725
Country	:	US
Telephone Number	:	787-747-1374
Fax Number	:	787-745-0549

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MICHELLE MARIE NAREDO
Credential	:
Telephone Number	:	787-747-1374

Provider Enumeration Date	:	09/23/2009
Last Update Date	:	09/23/2009

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