Provider Demographics
NPI:1710151717
Name:AUDIOLOGOS, CSP
Entity Type:Organization
Organization Name:AUDIOLOGOS, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:787-250-7471
Mailing Address - Street 1:LAS AMERICAS PROFESSIONAL CENTER
Mailing Address - Street 2:AVE. DOMENECH 400 OF. 206
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-250-7471
Mailing Address - Fax:787-756-7471
Practice Address - Street 1:LAS AMERICAS PROFESSIONAL CENTER
Practice Address - Street 2:AVE. DOMENECH 400 OF. 206
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-250-7471
Practice Address - Fax:787-756-7471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology SupplierGroup - Single Specialty