MEDICARE: KARLA I HADDOCK LEGARES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	15597	PR

General Provider Information

NPI Number	:	1649134412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARLA I HADDOCK LEGARES

Provider Business Mailing Address
First Line	:	14 SAN VICENTE MALL, SECTOR MELANIA BO JOBOS,
Second Line	:
City	:	GUAYAMA
State	:	PR
Zip	:	00784-6804
Country	:	US
Telephone Number	:	787-558-8718
Fax Number	:

Provider Business Practice Location Address
First Line	:	66 B C11 JOSEFINA LEGRAND
Second Line	:
City	:	CANOVANAS
State	:	PR
Zip	:	00729-0000
Country	:	US
Telephone Number	:	787-903-9863
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	04/08/2026

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