Provider Demographics
NPI:1134357296
Name:PROFESSIONAL HEARING & BALANCE CENTER
Entity type:Organization
Organization Name:PROFESSIONAL HEARING & BALANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST- PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YANISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:787-453-6373
Mailing Address - Street 1:150 VISTAS DE LOS FRAILES
Mailing Address - Street 2:CARR. 873 #84
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-453-6373
Mailing Address - Fax:
Practice Address - Street 1:200 AVE. WINSTON CHURCHILL
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6650
Practice Address - Country:US
Practice Address - Phone:787-759-7744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-29
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR597261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech