=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396970059
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELSA MARIA VELEZ ROMAN SPEECH LANGUAGE ASSI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2009
-----------------------------------------------------
Last Update Date | 06/01/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR 390 INT KM 0.4 BARRIO CUEVA
-----------------------------------------------------
City | PENUELAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-836-1618
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | VILLA GRILASCA 906 VIRGILIO BIAGGI
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-840-7928
-----------------------------------------------------
Fax | 787-290-2475
-----------------------------------------------------
=====================================================
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 | 1059
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------