Healthcare Provider Details

I. General information

NPI: 1992292783
Provider Name (Legal Business Name): YOLANDA GRAJALES MERCADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 KM 112
ISABELA PR
00662
US

IV. Provider business mailing address

26669 CARR 113
QUEBRADILLAS PR
00678-7334
US

V. Phone/Fax

Practice location:
  • Phone: 787-378-9807
  • Fax:
Mailing address:
  • Phone: 787-243-2443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4398
License Number StatePR

VII. Legacy identifiers

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

# 1
Identifier1071
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerSPEECH THERPY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: