Provider Demographics
NPI:1891091047
Name:CENTRO PONCENO DE AUTISMO
Entity Type:Organization
Organization Name:CENTRO PONCENO DE AUTISMO
Other - Org Name:CORPORACION PARA EL DESARROLLO DEL CENTRO PONCENO DE AUTISMO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DELIZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:787-284-2900
Mailing Address - Street 1:120 CALLE SOL
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-4881
Mailing Address - Country:US
Mailing Address - Phone:787-284-2900
Mailing Address - Fax:
Practice Address - Street 1:120 CALLE SOL
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-4881
Practice Address - Country:US
Practice Address - Phone:787-284-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-07
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental DisabilitiesGroup - Multi-Specialty
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental DisabilitiesGroup - Multi-Specialty