Healthcare Provider Details

I. General information

NPI: 1053668897
Provider Name (Legal Business Name): PAOLA OQUENDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 08/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2414 PASEO AMIR
TOA BAJA PR
00949-4316
US

IV. Provider business mailing address

2414 PASEO AMIR
TOA BAJA PR
00949-4316
US

V. Phone/Fax

Practice location:
  • Phone: 787-387-9153
  • Fax:
Mailing address:
  • Phone: 787-387-9153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number904
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: