Provider Demographics
NPI:1366974396
Name:CENTRO CIEHLO INC
Entity type:Organization
Organization Name:CENTRO CIEHLO INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OCUPPATIONAL THERAPIST
Authorized Official - Prefix:PROF
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:AIXA
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OTL
Authorized Official - Phone:787-801-2966
Mailing Address - Street 1:A49 CALLE MARGINAL
Mailing Address - Street 2:URBANIZACION BARALT
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:787-801-2966
Mailing Address - Fax:
Practice Address - Street 1:A49 CALLE MARGINAL
Practice Address - Street 2:URB. BARALT
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-3759
Practice Address - Country:US
Practice Address - Phone:787-801-2966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR589261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR589OtherMEDICAL INSURANCE