Healthcare Provider Details

I. General information

NPI: 1861087454
Provider Name (Legal Business Name): MILANY OQUENDO CARDONA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 03/04/2021
Certification Date: 02/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO GUATEMALA CARR 111 KM 16.8 INT
SAN SEBASTIAN PR
00685
US

IV. Provider business mailing address

HC 5 BOX 50202
SAN SEBASTIAN PR
00685-5785
US

V. Phone/Fax

Practice location:
  • Phone: 787-673-3514
  • Fax:
Mailing address:
  • Phone: 787-673-3514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number7216
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: