Provider Demographics
NPI:1306284047
Name:CLINICA DE SERVICIOS DE PATOLOGIA DEL HABLA Y LENGUAJE (CLISEP),C.S.P.
Entity type:Organization
Organization Name:CLINICA DE SERVICIOS DE PATOLOGIA DEL HABLA Y LENGUAJE (CLISEP),C.S.P.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAIZA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS-CCC-SLP
Authorized Official - Phone:787-901-7254
Mailing Address - Street 1:PO BOX 1720
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-1720
Mailing Address - Country:US
Mailing Address - Phone:787-901-7254
Mailing Address - Fax:
Practice Address - Street 1:346 AVE HOSTOS
Practice Address - Street 2:MEDICAL EMPORIUM II SUITE A31
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-265-0260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR907261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech