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General NPI Number Information
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NPI Number | 1487261665
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Entity Type | Individual
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Provider Name | MISS YARITZA EDITH CAMACHO ORTIZ
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Gender | Female
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Dates
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Enumeration Date | 09/30/2020
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | CARR. 160 BARRIO ALMIRANTE NORTE SECTOR EL INDIO C/CASIMAR #296
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City | VEGA BAJA
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State | PR
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Zip | 00693
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Country | US
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Telephone | 787-424-4803
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Fax |
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Provider Business Mailing Address
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Address Line | HC 5 BOX 50036
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City | VEGA BAJA
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State | PR
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Zip | 00693-9693
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 4056
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License Number State | PR
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