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General NPI Number Information
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NPI Number | 1992094981
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Entity Type | Organization
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Legal Business Name | PEKES EN DESARROLLO
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Dates
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Enumeration Date | 03/30/2011
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Last Update Date | 03/30/2011
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Provider Practice Location Address
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Address Line | 160 MARGINAL LAGO ALTO PLAZA SAN MIGUEL 207
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976-3906
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Country | US
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Telephone | 787-292-2534
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Fax |
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Provider Business Mailing Address
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Address Line | 160 MARGINAL LAGO ALTO PLAZA SAN MIGUEL 207
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976-3906
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Country | US
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Telephone | 787-292-2534
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Fax |
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Authorized Official
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Title or Position | DIRECTORA CLINICA/T.O
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Name | MRS. MELISSA GAVILAN
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Credential | OTL
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Telephone | 787-292-2534
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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 | 689
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number | 810
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License Number State | PR
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