Provider Demographics
NPI:1487322434
Name:EXPLORA CENTRO ACADEMICO Y TERAPUTICO LLC
Entity type:Organization
Organization Name:EXPLORA CENTRO ACADEMICO Y TERAPUTICO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:SARAI
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-640-5680
Mailing Address - Street 1:110 CALLE CARAZO
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5717
Mailing Address - Country:US
Mailing Address - Phone:787-640-5680
Mailing Address - Fax:
Practice Address - Street 1:110 CALLE CARAZO
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5717
Practice Address - Country:US
Practice Address - Phone:787-640-5680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0110OtherCOMERCIAL