Healthcare Provider Details

I. General information

NPI: 1063808483
Provider Name (Legal Business Name): SPEECH BUDDIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MF10 PLAZA 23 MONTE CLARO
BAYAMON PR
00961
US

IV. Provider business mailing address

G13C CALLE MILAN EXTENSION VILLA CAPARRA
GUAYNABO PR
00969
US

V. Phone/Fax

Practice location:
  • Phone: 939-579-3065
  • Fax:
Mailing address:
  • Phone: 939-579-3065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number2035
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number1066
License Number StatePR

VIII. Authorized Official

Name: CORAL M. RODRIGUEZ
Title or Position: SPEECH AND LANGUAGE PATHOLOGIST
Credential: M.S.
Phone: 939-579-3065