Healthcare Provider Details

I. General information

NPI: 1801205158
Provider Name (Legal Business Name): LA CLINICA DE LA ALBIZU MAYAGUEZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2014
Last Update Date: 08/20/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA #64 ESQUINA CALLE 3, URB INDUSTRIAL ALGARROBOS
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

PO BOX 9023711
SAN JUAN PR
00902-3711
US

V. Phone/Fax

Practice location:
  • Phone: 787-838-7272
  • Fax:
Mailing address:
  • Phone: 787-725-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIA C BUSTILLO
Title or Position: CLINICAL DIRECTOR
Credential: MS
Phone: 787-725-6500