Healthcare Provider Details

I. General information

NPI: 1720744154
Provider Name (Legal Business Name): SPECTRUM ABA SERVICES PR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 MARGINAL KENNEDY, EDIFICIO ILA 412
SAN JUAN PR
00920-0070
US

IV. Provider business mailing address

368 AVE SAN JOSE E
AIBONITO PR
00705-3719
US

V. Phone/Fax

Practice location:
  • Phone: 787-517-7970
  • Fax:
Mailing address:
  • Phone: 787-517-7970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: LAURA MALDONADO ALICEA
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 787-517-7970