Basic Information
Provider Information
NPI: 1326256819
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROHENA-PAGAN
FirstName: ALICIA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: AUD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 191079
Address2:  
City: SAN JUAN
State: PR
PostalCode: 009191079
CountryCode: US
TelephoneNumber: 7877773535
FaxNumber:  
Practice Location
Address1: CENTRO PEDIATRICO DE SERVICIOS DE HABILITACION - HPU
Address2: CALL BOX 191079
City: SAN JUAN
State: PR
PostalCode: 009191079
CountryCode: US
TelephoneNumber: 7877630550
FaxNumber: 7877631093
Other Information
ProviderEnumerationDate: 05/18/2007
LastUpdateDate: 10/02/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
231H00000X168PRY Speech, Language and Hearing Service ProvidersAudiologist 

No ID Information.


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