Healthcare Provider Details

I. General information

NPI: 1760677728
Provider Name (Legal Business Name): CENTRO NEYMAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

I7 AVE BETANCES HERAMANAS DAVILA
BAYAMON PR
00959-5109
US

IV. Provider business mailing address

PO BOX 504
BAYAMON PR
00960-0504
US

V. Phone/Fax

Practice location:
  • Phone: 787-780-2890
  • Fax: 787-785-4809
Mailing address:
  • Phone: 787-780-2890
  • Fax: 787-785-4809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number366
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number219
License Number StatePR

VIII. Authorized Official

Name: MRS. NEYSA ORRACA
Title or Position: DIRECTOR
Credential:
Phone: 787-780-2890