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General NPI Number Information
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NPI Number | 1306050166
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Entity Type | Organization
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Legal Business Name | PRACTICA INTRAMURAL DE AUDIOLOGIA
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | GALINDE ST. OFFICE G-12 EPS BUILDING AUDIOLOGY PROGRAM - MEDICAL SCIENCES CAMPUS
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City | SAN JUAN
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State | PR
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Zip | 00936-5067
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Country | US
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Telephone | 787-758-2525
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Fax | 787-765-6540
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Provider Business Mailing Address
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Address Line | GALINDE ST. AUDIOLOGY PROGRAM EPS BUILDING OFFICE 403 MEDICAL SCIENCES CAMPUS UPR POBOX 365067
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City | SAN JUAN
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State | PR
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Zip | 00936-5067
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Country | US
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Telephone | 787-758-2525
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Fax | 787-765-6540
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. GRACE ANN OWEN
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Credential | SC.D.
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Telephone | 787-758-2525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 529
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License Number State | PR
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