| Grupo Fisiatrico-dental Del Este, Corp. | |
|
Jardines De Rio Grande Calle 54 Bg-176 Rio Grande PR 00745 | |
| (787) 887-1110 | |
| (787) 888-7008 |
| Full Name | Grupo Fisiatrico-dental Del Este, Corp. |
|---|---|
| Speciality | Physical Medicine & Rehabilitation |
| Location | Jardines De Rio Grande, Rio Grande, Puerto Rico |
| Authorized Official Name and Position | Ricardo A Rodriguez (PRESIDENT) |
| Authorized Official Contact | 7878871110 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grupo Fisiatrico-dental Del Este, Corp. San Francisco 225 Calle Violeta San Juan PR 00927-6223 Ph: (787) 887-1110 | Grupo Fisiatrico-dental Del Este, Corp. Jardines De Rio Grande Calle 54 Bg-176 Rio Grande PR 00745 Ph: (787) 887-1110 |
| NPI Number | 1265874689 |
|---|---|
| Provider Enumeration Date | 07/26/2013 |
| Last Update Date | 06/02/2015 |
| Medicare PECOS PAC ID | 1052675493 |
|---|---|
| Medicare Enrollment ID | O20200204001468 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265874689 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 1780 (Puerto Rico) | Secondary |
| 208100000X | Physical Medicine & Rehabilitation | 10386 (Puerto Rico) | Primary |
| Provider Name | Ricardo A Rodriguez |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1457314957 PECOS PAC ID: 5799758819 Enrollment ID: I20040817000847 |
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