Healthcare Provider Details

I. General information

NPI: 1275793754
Provider Name (Legal Business Name): KIDSZONE DEVELOPMENTAL AND LANGUAGE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 MARGINAL KENNEDY EDIFICIO ILA 411-A
SAN JUAN PR
00920-1715
US

IV. Provider business mailing address

URB. RIBERAS DEL RIO F8 CALLE 6
BAYAMON PR
00959
US

V. Phone/Fax

Practice location:
  • Phone: 787-413-8068
  • Fax: 787-731-3420
Mailing address:
  • Phone: 787-413-8068
  • Fax: 787-731-3420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1096
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number456
License Number StatePR

VIII. Authorized Official

Name: MRS. JOAN M RIVERA TORO
Title or Position: PRESIDENT SPEECH PATHOLOGIST
Credential: MS CCC SLP
Phone: 787-413-8068