Provider Demographics
NPI:1114647849
Name:CENTRO DE INTEGRACION DESARROLLO Y AYUDA AL NINO ADULTO E INFANTE LLC
Entity Type:Organization
Organization Name:CENTRO DE INTEGRACION DESARROLLO Y AYUDA AL NINO ADULTO E INFANTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATOLOGA DEL HABLA Y LENGUAJE
Authorized Official - Prefix:
Authorized Official - First Name:MARA
Authorized Official - Middle Name:ITZEL
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:LCDA
Authorized Official - Phone:939-275-0591
Mailing Address - Street 1:3623 AVE MILITAR
Mailing Address - Street 2:SUITE 101 PMB 311
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662
Mailing Address - Country:US
Mailing Address - Phone:939-313-0343
Mailing Address - Fax:
Practice Address - Street 1:CARR. 2 KM 122.5
Practice Address - Street 2:BO. CAIMITAL ALTO
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:939-313-0343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech