Healthcare Provider Details

I. General information

NPI: 1508445321
Provider Name (Legal Business Name): JACQUELINE N GALARZA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. MARIANI 2961 AVE. ROOSEVELT A-1
PONCE PR
00717
US

IV. Provider business mailing address

2118 CALLE GRANADA
PONCE PR
00716-3822
US

V. Phone/Fax

Practice location:
  • Phone: 787-438-3117
  • Fax:
Mailing address:
  • Phone: 787-438-3117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number1289
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number5930
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: