Healthcare Provider Details

I. General information

NPI: 1598118564
Provider Name (Legal Business Name): SERVICIOS TERAPEUTICOS MAYARI, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SANTA ROSA MALL OFIC 202B
BAYAMON PR
00959-0000
US

IV. Provider business mailing address

SANTA ROSA MALL OFIC 202B
BAYAMON PR
00959
US

V. Phone/Fax

Practice location:
  • Phone: 787-780-6006
  • Fax:
Mailing address:
  • Phone: 787-780-6006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number626
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0155
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number237
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number723
License Number StatePR
# 5
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number003
License Number StatePR

VIII. Authorized Official

Name: MRS. SANDRA AISSA MATTOS
Title or Position: SPEECH AND LANGUAGE PATHOLOGIST
Credential: MS
Phone: 787-780-6006