Provider Demographics
NPI:1629633995
Name:CLINICA TERAPEUTICA DEL LENGUAJE
Entity Type:Organization
Organization Name:CLINICA TERAPEUTICA DEL LENGUAJE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATOLOGA DEL HABLA Y LENGUAJE
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BORRERO RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:787-223-4010
Mailing Address - Street 1:802 VILLAS DE RIO CANAS
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728
Mailing Address - Country:US
Mailing Address - Phone:787-223-4010
Mailing Address - Fax:
Practice Address - Street 1:5 CALLE MUNOZ RIVERA ESQ DR VEVE
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795
Practice Address - Country:US
Practice Address - Phone:787-677-4524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-02
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1558606624OtherSPEECH LANGUAGE PATHOLOGIST