Healthcare Provider Details

I. General information

NPI: 1619009768
Provider Name (Legal Business Name): CENTRO FAMILIAR DE SERVICIOS AUDIOLOGICOS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 04/16/2020
Certification Date: 04/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. ROBERTO CLEMENTE 2716
CAROLINA PR
00000-0985
US

IV. Provider business mailing address

URB VILLA ASTURIAS CALLE 31 31-1
CAROLINA PR
00000-0983
US

V. Phone/Fax

Practice location:
  • Phone: 787-762-3737
  • Fax: 787-762-3737
Mailing address:
  • Phone: 939-639-2845
  • Fax: 787-762-3737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name: MISS YESENIA GONZALEZ
Title or Position: PRESIDENT
Credential: M.S.
Phone: 787-762-3737