Provider Demographics
NPI:1417627373
Name:AXIS OF SYMMETRY
Entity Type:Organization
Organization Name:AXIS OF SYMMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CADIZ BLACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:787-354-2105
Mailing Address - Street 1:HC 3 BOX 18089
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-9398
Mailing Address - Country:US
Mailing Address - Phone:787-354-2105
Mailing Address - Fax:
Practice Address - Street 1:985 CARR 644
Practice Address - Street 2:1101 CANDOMINIO LAS MESAS
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-354-2105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine