Provider Demographics
NPI:1174707582
Name:INSTITUTO MANEJO DEL DOLOR DE PR Y EL CARIBE
Entity type:Organization
Organization Name:INSTITUTO MANEJO DEL DOLOR DE PR Y EL CARIBE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GERENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-641-9871
Mailing Address - Street 1:STREET # 165 LOS CANOS 100
Mailing Address - Street 2:CENTRO INT. DE MERCADEO 1 SUITE 301
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-0000
Mailing Address - Country:US
Mailing Address - Phone:787-641-9871
Mailing Address - Fax:787-848-0318
Practice Address - Street 1:STREET # 165 LOS CANOS 100
Practice Address - Street 2:CENTRO INT. DE MERCADEO 1 SUITE 301
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-0000
Practice Address - Country:US
Practice Address - Phone:787-641-9871
Practice Address - Fax:787-641-9874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR37261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain