Healthcare Provider Details

I. General information

NPI: 1861963522
Provider Name (Legal Business Name): PASOS PHL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2018
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 CALLE PIO RECHANI
AGUAS BUENAS PR
00703-3333
US

IV. Provider business mailing address

PO BOX 980
AGUAS BUENAS PR
00703-0980
US

V. Phone/Fax

Practice location:
  • Phone: 787-944-8044
  • Fax:
Mailing address:
  • Phone: 787-944-8044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. NITZELY HERNANDEZ PEREZ
Title or Position: PATOLOGA DE HABLA Y LENGUAJE
Credential: MS PHL
Phone: 787-944-8044