Healthcare Provider Details

I. General information

NPI: 1982372322
Provider Name (Legal Business Name): LA CLINICA DE LA ALBIZU SAN JUAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 09/01/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 CALLE TANCA
SAN JUAN PR
00902-3711
US

IV. Provider business mailing address

PO BOX 9023711
SAN JUAN PR
00902-3711
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIA C. BUSTILLO
Title or Position: SUPERVISORA
Credential: SLPD
Phone: 787-725-6500