Provider Demographics
NPI:1053721746
Name:CENTRO DE DESARROLLO Y SERVICIOS ESPECIALIZADOS, INC
Entity type:Organization
Organization Name:CENTRO DE DESARROLLO Y SERVICIOS ESPECIALIZADOS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:PROF
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUARDIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-834-7997
Mailing Address - Street 1:P.O. BOX 216
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00681
Mailing Address - Country:UM
Mailing Address - Phone:787-834-7997
Mailing Address - Fax:787-834-5451
Practice Address - Street 1:CARR. #349 KM. 3.1 CERRO LAS MESAS
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00680
Practice Address - Country:UM
Practice Address - Phone:787-834-7997
Practice Address - Fax:787-834-5451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR807225100000X
PR755225X00000X
PR623235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty