Healthcare Provider Details

I. General information

NPI: 1902966948
Provider Name (Legal Business Name): AUDIFONOS AUDIO CENTRO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 CALLE ENSENADA
SAN JUAN PR
00920-3501
US

IV. Provider business mailing address

PO BOX 11927
SAN JUAN PR
00922-1927
US

V. Phone/Fax

Practice location:
  • Phone: 787-781-3055
  • Fax: 787-781-4008
Mailing address:
  • Phone: 787-781-3055
  • Fax: 787-781-4008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number508
License Number StatePR

VIII. Authorized Official

Name: RAQUEL MARTINEZ
Title or Position: MANAGER
Credential:
Phone: 787-781-3055