Provider Demographics
NPI:1528122694
Name:CENTRO TERAPIA FISICA RIVERA NIEVES INC
Entity type:Organization
Organization Name:CENTRO TERAPIA FISICA RIVERA NIEVES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER FOR THERAPY CENTER
Authorized Official - Prefix:
Authorized Official - First Name:LILLIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA NIEVES
Authorized Official - Suffix:
Authorized Official - Credentials:THERAPIST
Authorized Official - Phone:787-883-3939
Mailing Address - Street 1:PO BOX 19
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-0019
Mailing Address - Country:US
Mailing Address - Phone:787-883-3939
Mailing Address - Fax:787-270-4933
Practice Address - Street 1:ST. 693 BARRIO BRENAS
Practice Address - Street 2:SUITE NO 271
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-883-3939
Practice Address - Fax:787-270-4933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1046302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR33-0422-1OtherACAA
PR56632OtherSSS-REFORMA
PRP715OtherINTL. MEDICAL CARD
PR56632OtherSSS-REFORMA