Provider Demographics
| NPI: | 1669797510 |
|---|---|
| Name: | CLINICA DE TERAPIA VEGA ALTA, CSP |
| Entity type: | Organization |
| Organization Name: | CLINICA DE TERAPIA VEGA ALTA, CSP |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRESIDENT |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | RUZ |
| Authorized Official - Middle Name: | NAHOMI |
| Authorized Official - Last Name: | COLON |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 787-270-1854 |
| Mailing Address - Street 1: | 207 CALLE D |
| Mailing Address - Street 2: | LAS COLINAS |
| Mailing Address - City: | VEGA ALTA |
| Mailing Address - State: | PR |
| Mailing Address - Zip Code: | 00692-7112 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 787-270-1854 |
| Mailing Address - Fax: | 787-270-1858 |
| Practice Address - Street 1: | 2 KM 29.4 |
| Practice Address - Street 2: | BO. ESPINOSA |
| Practice Address - City: | VEGA ALTA |
| Practice Address - State: | PR |
| Practice Address - Zip Code: | 00692 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 787-270-1854 |
| Practice Address - Fax: | 787-270-1858 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2010-04-05 |
| Last Update Date: | 2010-04-05 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | ||
| No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 2355S0801X | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant | Group - Multi-Specialty |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty |
