Healthcare Provider Details

I. General information

NPI: 1891602314
Provider Name (Legal Business Name): TATIANA DEL MAR LASSALLE CASTRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 107 KM 2.7, FARO 2
AGUADILLA PR
00603
US

IV. Provider business mailing address

HC 1 BOX 17439
AGUADILLA PR
00603-9359
US

V. Phone/Fax

Practice location:
  • Phone: 939-312-9079
  • Fax:
Mailing address:
  • Phone: 787-585-2520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5120-1
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: