Healthcare Provider Details

I. General information

NPI: 1205517158
Provider Name (Legal Business Name): ALBIZU CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 07/25/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 TANCA STREET
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: 787-993-3885
  • Fax:
Mailing address:
  • Phone: 787-993-3885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: DR. GILDA RODRIGUEZ
Title or Position: CLINIC DIRECTOR
Credential: PSY.D
Phone: 787-725-6500