Provider Demographics
NPI:1902966948
Name:AUDIFONOS AUDIO CENTRO INC
Entity Type:Organization
Organization Name:AUDIFONOS AUDIO CENTRO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-781-3055
Mailing Address - Street 1:PO BOX 11927
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-1927
Mailing Address - Country:US
Mailing Address - Phone:787-781-3055
Mailing Address - Fax:787-781-4008
Practice Address - Street 1:356 CALLE ENSENADA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-3501
Practice Address - Country:US
Practice Address - Phone:787-781-3055
Practice Address - Fax:787-781-4008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR508237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherAUDIFONOS AUDIOCENTRO