MEDICARE: SERVICIOS CLINICOS INTERDISCIPLINARIOS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	104100000X	Social Worker
2	101Y00000X	Counselor
3	235Z00000X	Speech-Language Pathologist
4	1041C0700X	Clinical Social Worker
5	111N00000X	Chiropractor
6	2084P0800X	Psychiatry Physician
7	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1669224200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERVICIOS CLINICOS INTERDISCIPLINARIOS LLC

Provider Business Mailing Address
First Line	:	1013 CALLE LOS FLAMBOYANES
Second Line	:
City	:	COTO LAUREL
State	:	PR
Zip	:	00780-2240
Country	:	US
Telephone Number	:	939-835-7173
Fax Number	:

Provider Business Practice Location Address
First Line	:	3020 AVE SAN CRISTOBAL
Second Line	:
City	:	COTO LAUREL
State	:	PR
Zip	:	00780-2896
Country	:	US
Telephone Number	:	939-835-7173
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT / OWNER
Name	:	GIOVANNI ALOMAR SASTRE
Credential	:	PH D
Telephone Number	:	939-835-7173

Provider Enumeration Date	:	04/05/2024
Last Update Date	:	04/05/2024

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