Healthcare Provider Details

I. General information

NPI: 1568383776
Provider Name (Legal Business Name): MARISOL BANCHS SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FARO 2 SUITE H CARR 107 BO BORINQUEN
AGUADILLA PR
00603
US

IV. Provider business mailing address

PO BOX 688
MAYAGUEZ PR
00681-0688
US

V. Phone/Fax

Practice location:
  • Phone: 939-312-9079
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4789
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: