Provider Demographics
NPI:1548475981
Name:INSTITUTO DE FISIATRIA Y MEDICINA DEPORTIVA DEL ESTE, INC
Entity type:Organization
Organization Name:INSTITUTO DE FISIATRIA Y MEDICINA DEPORTIVA DEL ESTE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSIATRIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:ARROYO
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-209-0696
Mailing Address - Street 1:PO BOX 1933
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-1933
Mailing Address - Country:US
Mailing Address - Phone:787-734-4305
Mailing Address - Fax:
Practice Address - Street 1:8 CALLE ALMODOVAR
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-3303
Practice Address - Country:US
Practice Address - Phone:787-734-4305
Practice Address - Fax:787-713-4444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13591261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation