Provider Demographics
NPI:1679891071
Name:KBAUCAGE FISIATRA
Entity type:Organization
Organization Name:KBAUCAGE FISIATRA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAUCAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-819-5900
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-0009
Mailing Address - Country:US
Mailing Address - Phone:787-819-5900
Mailing Address - Fax:787-882-5405
Practice Address - Street 1:SEVERIANO CUEVAS # 18
Practice Address - Street 2:HOSPITAL BUEN SAMARITANO
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5500
Practice Address - Country:US
Practice Address - Phone:787-891-4833
Practice Address - Fax:787-882-5405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)