Provider Demographics
NPI:1194170175
Name:INSTITUTO FISIATRICO DE AIBONITO CSP
Entity type:Organization
Organization Name:INSTITUTO FISIATRICO DE AIBONITO CSP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-486-7168
Mailing Address - Street 1:PO BOX 197
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:PR
Mailing Address - Zip Code:00786-0197
Mailing Address - Country:US
Mailing Address - Phone:787-735-2445
Mailing Address - Fax:787-991-0885
Practice Address - Street 1:110 CALLE JOSE C VAZQUEZ
Practice Address - Street 2:FRENTE HOSPITAL MENONITA
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-735-2445
Practice Address - Fax:787-991-0885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12266261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health