Provider Demographics
NPI:1134447766
Name:PUERTO RICO EAR CLINIC
Entity type:Organization
Organization Name:PUERTO RICO EAR CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ENID
Authorized Official - Middle Name:M
Authorized Official - Last Name:IRIZARRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-764-2860
Mailing Address - Street 1:500 MUNOZ RIVERA
Mailing Address - Street 2:EL CENTRO 2, 606
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3300
Mailing Address - Country:US
Mailing Address - Phone:787-764-2860
Mailing Address - Fax:
Practice Address - Street 1:500 MUNOZ RIVERA
Practice Address - Street 2:EL CENTRO 2, SUITE 606
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3300
Practice Address - Country:US
Practice Address - Phone:787-764-2860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty