=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245125913
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GISELLE M ROSA MARTELL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2025
-----------------------------------------------------
Last Update Date | 06/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | U16 CALLE 7 STE 1
-----------------------------------------------------
City | VEGA BAJA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00693-5702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-949-9018
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2757
-----------------------------------------------------
City | MOCA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00676-2757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-203-4231
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2355S0801X
-----------------------------------------------------
Taxonomy Name | Speech-Language Assistant
-----------------------------------------------------
License Number | 007633
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------