Provider Demographics
NPI:1306050166
Name:PRACTICA INTRAMURAL DE AUDIOLOGIA
Entity type:Organization
Organization Name:PRACTICA INTRAMURAL DE AUDIOLOGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:SCD
Authorized Official - Phone:787-758-2525
Mailing Address - Street 1:GALINDE ST. AUDIOLOGY PROGRAM EPS BUILDING OFFICE 403
Mailing Address - Street 2:MEDICAL SCIENCES CAMPUS UPR POBOX 365067
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-5067
Mailing Address - Country:US
Mailing Address - Phone:787-758-2525
Mailing Address - Fax:787-765-6540
Practice Address - Street 1:GALINDE ST. OFFICE G-12 EPS BUILDING
Practice Address - Street 2:AUDIOLOGY PROGRAM - MEDICAL SCIENCES CAMPUS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936-5067
Practice Address - Country:US
Practice Address - Phone:787-758-2525
Practice Address - Fax:787-765-6540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR529231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty