Provider Demographics
NPI:1366550287
Name:INSTITUTO METROPOLITANO DE MEDICINA FISICA
Entity type:Organization
Organization Name:INSTITUTO METROPOLITANO DE MEDICINA FISICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN & PM&R
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUOYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-775-2685
Mailing Address - Street 1:J16 CALLE 2
Mailing Address - Street 2:STE 110 EDIF MEDICO HNAS DAVILA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-5041
Mailing Address - Country:US
Mailing Address - Phone:787-775-2685
Mailing Address - Fax:
Practice Address - Street 1:1789 CARR 21
Practice Address - Street 2:STE 405 TORRE DEL METROPOLITANO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3333
Practice Address - Country:US
Practice Address - Phone:787-775-2685
Practice Address - Fax:787-277-0362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9894208100000X
PR11346208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
84401Medicare ID - Type Unspecified