Provider Demographics
NPI:1790035566
Name:WISCOVITCH, CHRISTIAN ALEXIS (MRC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIAN
Middle Name:ALEXIS
Last Name:WISCOVITCH
Suffix:
Gender:M
Credentials:MRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. REPARTO UNIVERSIDAD CALLE 1-K-1
Mailing Address - Street 2:P.O. B.O.X. 754
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-0068
Mailing Address - Country:US
Mailing Address - Phone:939-207-8770
Mailing Address - Fax:
Practice Address - Street 1:URB. REPARTO UNIVERSIDAD ST.#1
Practice Address - Street 2:K#1
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:939-207-8770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor