MEDICARE: NEYSSA MARINA ANDINO PENALOZA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant	1063	PR

General Provider Information

NPI Number	:	1194698670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEYSSA MARINA ANDINO PENALOZA

Provider Business Mailing Address
First Line	:	PO BOX 1709
Second Line	:
City	:	CAROLINA
State	:	PR
Zip	:	00984-1709
Country	:	US
Telephone Number	:	939-366-3028
Fax Number	:

Provider Business Practice Location Address
First Line	:	1232 CALLE JULIAN BENGOCHEA
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00924-4442
Country	:	US
Telephone Number	:	787-200-0567
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2025
Last Update Date	:	09/29/2025

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