Provider Demographics
NPI:1699064501
Name:OTOLOGICS, P.S.C.
Entity type:Organization
Organization Name:OTOLOGICS, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:LASALLE LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-833-2155
Mailing Address - Street 1:CPR PROFESIONAL BUILDING 55 CALLE DE DIEGO E
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-5079
Mailing Address - Country:US
Mailing Address - Phone:787-833-2155
Mailing Address - Fax:787-833-2680
Practice Address - Street 1:55 CALLE DE DIEGO E
Practice Address - Street 2:SUITE 105
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-5078
Practice Address - Country:US
Practice Address - Phone:787-833-2155
Practice Address - Fax:787-833-2680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF83887Medicare UPIN
PR0020154Medicare PIN