Healthcare Provider Details

I. General information

NPI: 1114181559
Provider Name (Legal Business Name): ANGELA ISABEL GAMARRA-RIVERA M.S. CCCSLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE FLAMBOYAN #1187, JARDIN BOTANICO SUR
SAN JUAN TERRITORY
00926-1117
UM

IV. Provider business mailing address

CALLE FLAMBOYAN #1187, JARDIN BOTANICO SUR
SAN JUAN TERRITORY
00926-1117
UM

V. Phone/Fax

Practice location:
  • Phone: 787-764-6035
  • Fax:
Mailing address:
  • Phone: 787-764-6035
  • Fax: 787-754-8034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number783
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: