Provider Demographics
NPI:1982811907
Name:MILLAN, ALVIN (PHL)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:
Last Name:MILLAN
Suffix:
Gender:M
Credentials:PHL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SAN PATRICIO AA-15 ALTS DE SAN PEDRO
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:787-863-7169
Mailing Address - Fax:
Practice Address - Street 1:AA15 CALLE SAN PATRICIO
Practice Address - Street 2:ALT SAN PEDRO
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-5032
Practice Address - Country:US
Practice Address - Phone:787-863-7169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR512235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist