MEDICARE: PROFESSIONAL HEARING & BALANCE CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0700X	Hearing and Speech Clinic/Center	597	PR

General Provider Information

NPI Number	:	1134357296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL HEARING & BALANCE CENTER

Provider Business Mailing Address
First Line	:	150 VISTAS DE LOS FRAILES
Second Line	:	CARR. 873 #84
City	:	GUAYNABO
State	:	PR
Zip	:	00969
Country	:	US
Telephone Number	:	787-453-6373
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 AVE. WINSTON CHURCHILL
Second Line	:	SUITE 301
City	:	SAN JUAN
State	:	PR
Zip	:	00926-6650
Country	:	US
Telephone Number	:	787-759-7744
Fax Number	:

Authorized Official
Title or Position	:	AUDIOLOGIST- PRESIDENT
Name	:	YANISSA MORALES VELEZ
Credential	:	M.S.
Telephone Number	:	787-453-6373

Provider Enumeration Date	:	06/29/2009
Last Update Date	:	10/07/2009

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