Provider Demographics
NPI:1740842871
Name:PATAKA PITIKI CLINICA DE TERAPIAS, LLC
Entity type:Organization
Organization Name:PATAKA PITIKI CLINICA DE TERAPIAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:YANIELLIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:787-980-8151
Mailing Address - Street 1:173 CALLE LIRIO
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-2212
Mailing Address - Country:US
Mailing Address - Phone:787-980-8151
Mailing Address - Fax:
Practice Address - Street 1:CARR 857 KM 0.4
Practice Address - Street 2:BARRIO CANOVANILLAS
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-980-8151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty