Provider Demographics
NPI:1043441843
Name:AVANCE: CLINICA DE SERVICIOS RELACIONADOS A LA SALUD, CSP
Entity Type:Organization
Organization Name:AVANCE: CLINICA DE SERVICIOS RELACIONADOS A LA SALUD, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOCELLYN
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:787-647-9831
Mailing Address - Street 1:COND CORDOVA PARK
Mailing Address - Street 2:400 BO TORTUGO APT. 47
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9769
Mailing Address - Country:US
Mailing Address - Phone:787-648-4163
Mailing Address - Fax:
Practice Address - Street 1:CALLE MAYAGUEZ # 52
Practice Address - Street 2:
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00917-5102
Practice Address - Country:US
Practice Address - Phone:787-647-9831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty