Provider Demographics
NPI:1801205158
Name:LA CLINICA DE LA ALBIZU MAYAGUEZ
Entity Type:Organization
Organization Name:LA CLINICA DE LA ALBIZU MAYAGUEZ
Other - Org Name:UNIVERSIDAD CARLOS ALBIZU
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BUSTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:787-725-6500
Mailing Address - Street 1:PO BOX 9023711
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00902-3711
Mailing Address - Country:US
Mailing Address - Phone:787-725-6500
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA #64 ESQUINA CALLE 3,
Practice Address - Street 2:URB INDUSTRIAL ALGARROBOS
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-838-7272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSIDAD CARLOS ALBIZU
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-11
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty