Provider Demographics
NPI:1548680705
Name:CLINICA DE MANEJO DEL DOLOR DR JOSE R OLLER LOPEZ CSP
Entity type:Organization
Organization Name:CLINICA DE MANEJO DEL DOLOR DR JOSE R OLLER LOPEZ CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:OLLER LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-464-6369
Mailing Address - Street 1:558 CALLE BADAJOZ
Mailing Address - Street 2:MANSIONES CIUDAD JARDIN
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00705
Mailing Address - Country:US
Mailing Address - Phone:787-464-6369
Mailing Address - Fax:787-735-7613
Practice Address - Street 1:CARR 167 MARGINAL B4
Practice Address - Street 2:FORREST HILLS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-464-6369
Practice Address - Fax:787-735-7613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13903261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain