Healthcare Provider Details

I. General information

NPI: 1891091047
Provider Name (Legal Business Name): CENTRO PONCENO DE AUTISMO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CALLE SOL
PONCE PR
00730-4881
US

IV. Provider business mailing address

120 CALLE SOL
PONCE PR
00730-4881
US

V. Phone/Fax

Practice location:
  • Phone: 787-284-2900
  • Fax:
Mailing address:
  • Phone: 787-284-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LAURA M. DELIZ
Title or Position: DIRECTOR
Credential: PSYD
Phone: 787-284-2900