Healthcare Provider Details

I. General information

NPI: 1326863515
Provider Name (Legal Business Name): SENSORY BRAIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO. CANABONCITO, SECTOR LA SIERRA, CARR. 172 KM.20.6
CAGUAS PR
00725
US

IV. Provider business mailing address

URB BAIROA GOLDEN GATE II Q8 CALLE G
CAGUAS PR
00727-1146
US

V. Phone/Fax

Practice location:
  • Phone: 939-317-3984
  • Fax:
Mailing address:
  • Phone: 787-202-9850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JINNERVA MIRANDA POLANCO
Title or Position: PRESIDENT
Credential: SLP
Phone: 787-202-9850