Healthcare Provider Details

I. General information

NPI: 1588248975
Provider Name (Legal Business Name): EDNA N PIMENTEL ED.D. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27-16 AVE ROBERTO CLEMENTE
CAROLINA PR
00985-5420
US

IV. Provider business mailing address

HILL BROTHERS 387-B CALLE 11
SAN JUAN PR
00924
US

V. Phone/Fax

Practice location:
  • Phone: 787-276-8123
  • Fax:
Mailing address:
  • Phone: 787-340-1899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number866
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: