Provider Demographics
NPI:1003056318
Name:SPEECH PATHOLOGY DIAGNOSTIC & TREATMENT CENTER, INC.
Entity Type:Organization
Organization Name:SPEECH PATHOLOGY DIAGNOSTIC & TREATMENT CENTER, INC.
Other - Org Name:CENTRO TERAPEUTICO SANTA MARIA
Other - Org Type:Other Name
Authorized Official - Title/Position:PATOLOGO DEL HABLA Y LENGUAJE
Authorized Official - Prefix:MR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-448-6561
Mailing Address - Street 1:105 CALLE SAUCO
Mailing Address - Street 2:SANTA MARIA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6718
Mailing Address - Country:US
Mailing Address - Phone:787-448-6561
Mailing Address - Fax:
Practice Address - Street 1:105 CALLE SAUCO
Practice Address - Street 2:SANTA MARIA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-6718
Practice Address - Country:US
Practice Address - Phone:787-448-6561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15182235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty