Organization
CLUB DEL DESARROLLO INTEGRAL, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAUL RIVERA VEGA (PRESIDENT)
(787) 790-1583
Entity
Organization
Contact information
Practice address
110 CALLE CARAZO, GUAYNABO, PR 00969-5717
(787) 790-1583
Mailing address
110 CALLE CARAZO, GUAYNABO, PR 00969-5717
(787) 790-1583
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
1008
PR
261QP2000X
Physical Therapy Clinic/Center
1361
PR
Other
Enumeration date
03/24/2017
Last updated
03/24/2017
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