Provider Demographics
NPI:1841345410
Name:CLINICA DE TERAPIA FISICA FLAMINGO TERRACE
Entity type:Organization
Organization Name:CLINICA DE TERAPIA FISICA FLAMINGO TERRACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-430-1644
Mailing Address - Street 1:CARR 167 MARGINAL A-9
Mailing Address - Street 2:FLAMINGO TERRACE
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957
Mailing Address - Country:US
Mailing Address - Phone:787-279-0324
Mailing Address - Fax:939-337-6678
Practice Address - Street 1:A9 CALLE MARGINAL
Practice Address - Street 2:URB FLAMINGO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-279-0324
Practice Address - Fax:787-279-0324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0084107Medicare ID - Type Unspecified