Provider Demographics
NPI:1407062078
Name:CENTRO DE PATOLOGIA DEL HABLA Y AUDICION, INC
Entity Type:Organization
Organization Name:CENTRO DE PATOLOGIA DEL HABLA Y AUDICION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANAMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-285-3978
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-0579
Mailing Address - Country:US
Mailing Address - Phone:787-285-3978
Mailing Address - Fax:787-285-3978
Practice Address - Street 1:100 CALLE FONT MARTELO W STE 10
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3926
Practice Address - Country:US
Practice Address - Phone:787-285-3978
Practice Address - Fax:787-285-3978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR537231H00000X
PR601235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0060256Medicare ID - Type Unspecified