Basic Information
| Provider Information | |||||||||
| NPI: | 1255673067 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRECISION HEARING & BALANCE CENTER OF PUERTO RICO PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 193069 | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009193069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877610036 | ||||||||
| FaxNumber: | 7872925050 | ||||||||
| Practice Location | |||||||||
| Address1: | CARR. 845 KM 2.2 | ||||||||
| Address2: | AVE FAIR VIEW D 36 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877610036 | ||||||||
| FaxNumber: | 7872925050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2013 | ||||||||
| LastUpdateDate: | 12/20/2018 | ||||||||
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| AuthorizedOfficialLastName: | PORTELA SANCHEZ | ||||||||
| AuthorizedOfficialFirstName: | IAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7877610036 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0700X | 094 | PR | N | Ambulatory Health Care Facilities | Clinic/Center | Hearing and Speech | 111N00000X | 0570 | PR | N | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor | 208100000X | PR | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 225100000X | 933 | PR | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 231H00000X | PR | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist | 235Z00000X | 330 | PR | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 2081S0010X | PR | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine |
No ID Information.