Healthcare Provider Details

I. General information

NPI: 1801146717
Provider Name (Legal Business Name): CLINICA STEP CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 06/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PR2 86 6
HATILLO PR
00659
US

IV. Provider business mailing address

PO BOX 1386
HATILLO PR
00659-1386
US

V. Phone/Fax

Practice location:
  • Phone: 787-410-7108
  • Fax: 787-898-3054
Mailing address:
  • Phone: 787-410-7108
  • Fax: 787-898-3054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3133
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1577
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1577
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number966
License Number StatePR
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number844
License Number StatePR
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number753
License Number StatePR
# 7
Primary TaxonomyN
Taxonomy Code261QA3000X
TaxonomyAugmentative Communication Clinic/Center
License Number753
License Number StatePR
# 8
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number753
License Number StatePR

VIII. Authorized Official

Name: MARIA DEL C GARCIA
Title or Position: SLP
Credential: M.S.
Phone: 787-410-7108