Healthcare Provider Details

I. General information

NPI: 1528476504
Provider Name (Legal Business Name): DELMA I SANTOS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 07/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E23 CALLE 10 SANTA RITA
VEGA ALTA PR
00692-6723
US

IV. Provider business mailing address

E23 CALLE 10 SANTA RITA
VEGA ALTA PR
00692-6723
US

V. Phone/Fax

Practice location:
  • Phone: 787-438-6588
  • Fax:
Mailing address:
  • Phone: 787-438-6588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number836
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number792
License Number StatePR

VIII. Authorized Official

Name: DELMA I SANTOS
Title or Position: GROUP DIRECTOR
Credential: SLP
Phone: 787-438-6588