Provider Demographics
NPI:1114656402
Name:ARECIBO AUDIOLOGY LLC
Entity Type:Organization
Organization Name:ARECIBO AUDIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/AUDIOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:ISAMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ FELICIANO
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:787-816-3195
Mailing Address - Street 1:HC 2 BOX 16367
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-9380
Mailing Address - Country:US
Mailing Address - Phone:787-816-3195
Mailing Address - Fax:787-816-0371
Practice Address - Street 1:CARR 651 KM 5.2 BO DOMINGUITO
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-816-3195
Practice Address - Fax:787-816-0371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty