# CLUB DEL DESARROLLO INTEGRAL, PSC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134650880
- **Authorized official:** MR. RAUL RIVERA VEGA (PRESIDENT)
- **Authorized official phone:** (787) 790-1583

## Contact information

- **Practice address:** 110 CALLE CARAZO, GUAYNABO, PR 00969-5717
- **Practice address phone:** (787) 790-1583
- **Mailing address:** 110 CALLE CARAZO, GUAYNABO, PR 00969-5717
- **Mailing address phone:** (787) 790-1583

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | 1008 | PR | Yes |
| 261QP2000X | Physical Therapy Clinic/Center | 1361 | PR | — |

## Other

- **Enumeration date:** 03/24/2017
- **Last updated:** 03/24/2017