Healthcare Provider Details

I. General information

NPI: 1184755472
Provider Name (Legal Business Name): AUDIOLOGY CLINICS OF PUERTO RICO, CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 PONCE BYP STE 406
PONCE PR
00717-1322
US

IV. Provider business mailing address

2225 PONCE BYP STE 406
PONCE PR
00717-1322
US

V. Phone/Fax

Practice location:
  • Phone: 787-844-8595
  • Fax: 787-848-8179
Mailing address:
  • Phone: 787-844-8595
  • Fax: 787-848-8179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK MCDOWALL
Title or Position: DIRECTOR
Credential: PH.D.
Phone: 787-844-8595