MEDICARE: HABLAME CLINICA TERAPEUTICA

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	261QH0700X	Hearing and Speech Clinic/Center	978	PR

General Provider Information

NPI Number	:	1174069751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HABLAME CLINICA TERAPEUTICA

Provider Business Mailing Address
First Line	:	PO BOX 686
Second Line	:
City	:	COAMO
State	:	PR
Zip	:	00769-0686
Country	:	US
Telephone Number	:	787-929-1513
Fax Number	:

Provider Business Practice Location Address
First Line	:	CARR 153 KM 12.4 LOCAL 3
Second Line	:	BO LAS FLORES
City	:	COAMO
State	:	PR
Zip	:	00769-9998
Country	:	US
Telephone Number	:	787-929-1513
Fax Number	:

Authorized Official
Title or Position	:	SPEECH-LANGUAGE PATHOLOGIST
Name	:	MRS. SUSANA MONTANEZ GONZALEZ
Credential	:
Telephone Number	:	787-929-1513

Provider Enumeration Date	:	01/06/2017
Last Update Date	:	01/06/2017

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