Healthcare Provider Details

I. General information

NPI: 1932522679
Provider Name (Legal Business Name): BEATRIZ RESTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2014
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CATALANA #66 EDIFICIO 1
BARCELONETA PR
00617
US

IV. Provider business mailing address

URB. LA ESPERANZA, CALLE 6 F 29
VEGA ALTA PR
00692
UM

V. Phone/Fax

Practice location:
  • Phone: 787-493-0300
  • Fax:
Mailing address:
  • Phone: 787-453-4968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number1317
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1317
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerLIC PROFESIONAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: