Healthcare Provider Details

I. General information

NPI: 1316704950
Provider Name (Legal Business Name): MISS KATIRIA MICHELLE MEJIAS FORNES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 AVE. VIRGILIO BIAGGI, URB. VILLA GRILLASCA
PONCE PR
00717-1108
US

IV. Provider business mailing address

HC 01 BOX 11176
PENUELAS PR
00624
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-7928
  • Fax:
Mailing address:
  • Phone: 787-202-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number7547
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: