Healthcare Provider Details

I. General information

NPI: 1669797510
Provider Name (Legal Business Name): CLINICA DE TERAPIA VEGA ALTA, CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 04/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 KM 29.4 BO. ESPINOSA
VEGA ALTA PR
00692
US

IV. Provider business mailing address

207 CALLE D LAS COLINAS
VEGA ALTA PR
00692-7112
US

V. Phone/Fax

Practice location:
  • Phone: 787-270-1854
  • Fax: 787-270-1858
Mailing address:
  • Phone: 787-270-1854
  • Fax: 787-270-1858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RUZ NAHOMI COLON
Title or Position: PRESIDENT
Credential:
Phone: 787-270-1854