Basic Information
| Provider Information | |||||||||
| NPI: | 1679169379 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEREZ RAMOS | ||||||||
| FirstName: | GLENDA | ||||||||
| MiddleName: | L | ||||||||
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| Mailing Information | |||||||||
| Address1: | URB SAN RAFAEL | ||||||||
| Address2: | CALLE SAN MARTIN 26 | ||||||||
| City: | ARECINO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00612 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | AVE. MUNOZ RIVERA EDIFICIO 309 | ||||||||
| Address2: | BO PUENTE SECTOR ALCANTARILLA | ||||||||
| City: | CAMUY | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7879153000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2020 | ||||||||
| LastUpdateDate: | 12/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2355S0801X | 879 | PR | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant |
ID Information
| ID | Type | State | Issuer | Description | 4529949 | 01 | PR | ID | OTHER |