Healthcare Provider Details

I. General information

NPI: 1114970449
Provider Name (Legal Business Name): OOTSCAN AUDIOLOGY, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE ROOSEVELT TORRE PLAZA LAS AMERICAS SUITE 402 CUARTO PISO
SAN JUAN PR
00917-2710
US

IV. Provider business mailing address

AVE ROOSEVELT TORRE PLAZA LAS AMERICAS SUITE 402 CUARTO PISO
SAN JUAN PR
00917-2710
US

V. Phone/Fax

Practice location:
  • Phone: 787-756-6560
  • Fax: 787-756-7456
Mailing address:
  • Phone: 787-756-6560
  • Fax: 787-756-7456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number505
License Number StatePR

VIII. Authorized Official

Name: DR. ELAINE FRANCES KOLODZIEJ
Title or Position: PRESIDENT-AUDIOLOGIST
Credential: AUD
Phone: 787-756-6560