Healthcare Provider Details

I. General information

NPI: 1982811907
Provider Name (Legal Business Name): ALVIN MILLAN PHL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AA15 CALLE SAN PATRICIO ALT SAN PEDRO
FAJARDO PR
00738-5032
US

IV. Provider business mailing address

SAN PATRICIO AA-15 ALTS DE SAN PEDRO
FAJARDO PR
00738
US

V. Phone/Fax

Practice location:
  • Phone: 787-863-7169
  • Fax:
Mailing address:
  • Phone: 787-863-7169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number512
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: