Provider Demographics
NPI:1730155235
Name:CENTRO FISIATRICO Y MEDICINA DEPORTIVA ERJ CSP
Entity type:Organization
Organization Name:CENTRO FISIATRICO Y MEDICINA DEPORTIVA ERJ CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ROBERTO
Authorized Official - Last Name:JAVIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-258-3275
Mailing Address - Street 1:201 AVE GAUTIER BENITEZ
Mailing Address - Street 2:SUITE 031
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-258-3275
Mailing Address - Fax:787-258-3212
Practice Address - Street 1:201 AVE. GAUTIER BENITEZ
Practice Address - Street 2:SUITE 308
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-258-3275
Practice Address - Fax:787-258-3212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11945174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR223220OtherPREFERRED HEALTH
PRPE 4628OtherPAN AMERICAN LIFE INSURAN
PR1678AOtherPREFFERED MEDICAL CHOICE
PR061142OtherCRUZ AZUL
PR03559OtherAMERICAN HEALTH
PRP521OtherINTERNATIONAL MEDICAL CAR
PR7310346OtherHUMANA HEALTH
PR7716OtherAMERICAN HEALTH MEDICARE
PR84873OtherSSS
PRP521OtherINTERNATIONAL MEDICAL CAR