MEDICARE: CENTRO ESPECIALIZADO EN TERAPIAS E INTEGRACION SENSORIAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1154660983
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRO ESPECIALIZADO EN TERAPIAS E INTEGRACION SENSORIAL

Provider Business Mailing Address
First Line	:	1253 AVE AMERICO MIRANDA
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00921-1619
Country	:	US
Telephone Number	:	787-792-6702
Fax Number	:

Provider Business Practice Location Address
First Line	:	1253 AVE AMERICO MIRANDA
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00921-1619
Country	:	US
Telephone Number	:	787-792-6702
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. MELANIE MANGUAL
Credential	:
Telephone Number	:	787-792-6702

Provider Enumeration Date	:	02/14/2013
Last Update Date	:	02/14/2013

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