Provider Demographics
NPI:1912070822
Name:PM & R MEDICAL DIAGNOSTICS PSC
Entity type:Organization
Organization Name:PM & R MEDICAL DIAGNOSTICS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:C
Authorized Official - Last Name:RIVERA MORALES
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:787-599-9999
Mailing Address - Street 1:45 CALLE TROPICAL
Mailing Address - Street 2:URB. MUNOZ RIVERA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5559
Mailing Address - Country:US
Mailing Address - Phone:787-599-9999
Mailing Address - Fax:787-789-4874
Practice Address - Street 1:45 CALLE TROPICAL
Practice Address - Street 2:URB. MUNOZ RIVERA
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-3703
Practice Address - Country:US
Practice Address - Phone:787-599-9999
Practice Address - Fax:787-789-4874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10944208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0083639Medicare ID - Type Unspecified