Healthcare Provider Details

I. General information

NPI: 1093140964
Provider Name (Legal Business Name): CLINICA DE TERAPIA HORIZONTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1262 AVE AMERICO MIRANDA
SAN JUAN PR
00921-1620
US

IV. Provider business mailing address

E10 CALLE NUEVA
GUAYNABO PR
00969-5006
US

V. Phone/Fax

Practice location:
  • Phone: 787-783-3800
  • Fax:
Mailing address:
  • Phone: 787-783-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: BELMAR RIVERA
Title or Position: SPEECH AND LANGUAGE PATHOLIGIST
Credential: MS
Phone: 787-783-3800